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Background <p>Cardiovascular–kidney–metabolic (CKM) syndrome underscores the interlinked pathophysiology of metabolic dysregulation, chronic kidney disease, and cardiovascular disease (CVD). Although depression is a key psychosocial factor, evidence linking its longitudinal trajectories to incident CVD among middle-aged and older adults with CKM stages 0–3 remains limited.</p> Methods <p>We conducted a prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2020, including participants at CKM stages 0–3. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) across the 2011, 2013, and 2015 waves. Group-based trajectory modeling (GBTM) was applied to identify depressive symptom trajectories. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD (including heart disease and stroke).</p> Results <p>Among 6,152 participants (49% male, median age 58.0 years), 1,080 incident CVD events occurred during the follow-up. We identified three distinct depressive symptom trajectories: Low-stable, Moderate-stable, and Persistently-high. The cumulative incidence of CVD across these groups was 13.0%, 17.3%, and 23.1%, respectively (<i>P</i> &lt; 0.001). Relative to the Low-stable group, fully adjusted Cox models revealed a significantly higher risk of incident CVD in both the Moderate-stable (HR = 1.36; 95% CI: 1.16–1.60) and Persistently-high (HR = 1.88; 95% CI: 1.57–2.24) groups. Consistent risk elevations were observed for coronary heart disease and stroke analyzed separately.</p> Conclusion <p>In Chinese middle-aged and older adults with CKM stages 0–3, depressive symptom trajectories are heterogeneous. Both Persistently-high and Moderate-stable trajectories of elevated depressive symptoms are independently associated with an increased risk of incident CVD.</p>

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Relationship between depressive symptom trajectories and cardiovascular disease risk in middle-aged and older adults with cardiovascular-kidney-metabolic syndrome stages 0–3

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月17日

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  • Mingkun Yang,
  • Yanwen Lu,
  • Yijing Liu,
  • Pan Xindian,
  • Yifeng Chen,
  • Xiaofeng Zhang,
  • Weihang Hu,
  • Jing Yan

摘要

Background

Cardiovascular–kidney–metabolic (CKM) syndrome underscores the interlinked pathophysiology of metabolic dysregulation, chronic kidney disease, and cardiovascular disease (CVD). Although depression is a key psychosocial factor, evidence linking its longitudinal trajectories to incident CVD among middle-aged and older adults with CKM stages 0–3 remains limited.

Methods

We conducted a prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2020, including participants at CKM stages 0–3. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) across the 2011, 2013, and 2015 waves. Group-based trajectory modeling (GBTM) was applied to identify depressive symptom trajectories. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD (including heart disease and stroke).

Results

Among 6,152 participants (49% male, median age 58.0 years), 1,080 incident CVD events occurred during the follow-up. We identified three distinct depressive symptom trajectories: Low-stable, Moderate-stable, and Persistently-high. The cumulative incidence of CVD across these groups was 13.0%, 17.3%, and 23.1%, respectively (P < 0.001). Relative to the Low-stable group, fully adjusted Cox models revealed a significantly higher risk of incident CVD in both the Moderate-stable (HR = 1.36; 95% CI: 1.16–1.60) and Persistently-high (HR = 1.88; 95% CI: 1.57–2.24) groups. Consistent risk elevations were observed for coronary heart disease and stroke analyzed separately.

Conclusion

In Chinese middle-aged and older adults with CKM stages 0–3, depressive symptom trajectories are heterogeneous. Both Persistently-high and Moderate-stable trajectories of elevated depressive symptoms are independently associated with an increased risk of incident CVD.