OBJECTIVE: To examine the association of depressive symptoms with cardiovascular disease (CVD) risk in middle-aged and older adults with Cardiovascular-Kidney-Metabolic (CKM) syndrome stages 0-3 and to assess whether this association varies by CKM syndrome stages. Also, interactions of depressive symptoms with CKM syndrome stages in relation to CVD risk were evaluated.
METHODS: This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS). Incident CVD events were identified based on self-reported physician-diagnosed (Participants were asked whether they had ever been diagnosed with disease by a physician). Cox proportional hazards regression models were used to estimate the association between depressive symptoms and CVD risk with interaction analyses across CKM syndrome stages.
RESULTS: Among 3440 participants, 1833 (53.3 %) were women. Over the 7-year follow-up, 696 (20.2 %) developed CVD. After full adjustment, elevated depressive symptoms were associated with a 27.0 % higher CVD risk (HR, 1.27; 95 % CI, 1.07-1.50). Of the 10 individual depressive symptoms, only restless sleep (HR, 1.23; 95 % CI, 1.04-1.44), loneliness (HR, 1.26; 95 % CI, 1.05-1.52), and bothered by little things (HR, 1.21; 95 % CI, 1.01-1.45) were significantly associated with incident CVD. Moreover, depressive symptoms and CKM syndrome stages exhibited both multiplicative and additive interactions. Notably, in CKM syndrome stage 3, depressive symptoms were associated with a 36.0 % higher CVD risk (HR, 1.36; 95 % CI, 1.09-1.70).
CONCLUSIONS: Elevated depressive symptoms are associated with increased CVD risk in middle-aged and older adults with CKM syndrome stages 0-3, with a synergistic effect observed as CKM syndrome progresses. Highlighting the integration of mental health assessments into CKM risk stratification may enhance early intervention strategies and reduce CVD burden.
