Association of cardiometabolic index and depressive symptoms with cardiovascular and cerebrovascular diseases in middle-aged and older adults: A national prospective cohort study

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2025-07-18 DOI:10.1016/j.jad.2025.119940

Xiaopeng Cui , Yunsheng Zhang , Yujing Jin , Zhuolin Wu , Ying Gao , Haiyan Su , Qing Zhang , Liang Wang , Xinyu Yang

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Abstract

Background

Cardiovascular diseases (CVDs) are the leading cause of mortality globally, with ischemic heart disease and stroke being the primary contributors. Despite the widespread use of traditional risk assessment models, new biomarkers are needed to enhance predictive accuracy. Depression and cardiometabolic index (CMI) are strongly associated with CVD risk, but their combined effect remains understudied. This study aimed to examine the association between depression and CMI, individually or in combination, and the incidence of CVD in middle-aged and older adults.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS), 5808 adults aged 45 years and older were included in this analysis. Cox proportional hazard models assessed both the individual and combined effects of depression and CMI on CVD risk. Causal mediation analysis further explored the potential mediating effects of depression and CMI on CVD.

Results

During 9 years of follow-up, CVD occurred in 1140 participants, including 843 cases of coronary heart disease and 408 strokes. Following the adjustment for sociodemographic factors and health-related variables, a higher CMI was found to be significantly associated with an increased risk of stroke (HR: 2.015, 95 % CI: 1.458–2.786) and CVD (HR: 1.284, 95 % CI: 1.072–1.537). Additionally, depressive symptoms were significantly linked to an elevated risk of CVD (HR: 1.472, 95 % CI: 1.296–1.671). The highest incidence of CVD was found in those with a combination of depression and high CMI (HR: 1.647, 95 % CI: 1.319–2.056). Subgroup analyses revealed significant heterogeneity in the association of age, gender, education level, and chronic disease status in the risk of CVD. Mediation analyses showed a small indirect effect of CMI on CVD through depressive symptoms (ACME: -0.00186, 95 % CI: −0.00410-0.00), whereas the indirect effect of depressive symptoms on CVD through CMI was significant (ACME: -0.00108, 95 % CI: −0.00243 -0.00).

Conclusions

Both depression and CMI demonstrated significant associations with the risk of CVD. Furthermore, the likelihood of CVD occurrence was notably higher when both factors coexisted. The mediation analysis suggests that depression modulates CVD risk through metabolic abnormalities, providing an important basis for further pathological mechanism studies and comprehensive intervention strategies.

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中老年人心血管代谢指数和抑郁症状与心脑血管疾病的关系：一项全国前瞻性队列研究

背景：心血管疾病（cvd）是全球死亡的主要原因，缺血性心脏病和中风是主要原因。尽管传统的风险评估模型被广泛使用，但需要新的生物标志物来提高预测的准确性。抑郁和心脏代谢指数（CMI）与CVD风险密切相关，但它们的联合作用仍未得到充分研究。本研究旨在探讨抑郁症和CMI（单独或联合）之间的关系，以及中老年人CVD的发病率。方法：使用中国健康与退休纵向研究（CHARLS）的数据，将5808名年龄在45岁 及以上的成年人纳入本分析。Cox比例风险模型评估了抑郁和CMI对CVD风险的个体和联合影响。因果中介分析进一步探讨抑郁和CMI对CVD的潜在中介作用。结果：在9 年的随访中，有1140名参与者发生了心血管疾病，其中包括843例冠心病和408例中风。在对社会人口因素和健康相关变量进行调整后，发现较高的CMI与卒中（HR: 2.015, 95 % CI: 1.458-2.786）和心血管疾病（HR: 1.284, 95 % CI: 1.072-1.537）的风险增加显著相关。此外，抑郁症状与CVD风险升高显著相关（HR: 1.472, 95 % CI: 1.296-1.671）。合并抑郁和高CMI的患者CVD发病率最高（HR: 1.647, 95 % CI: 1.319-2.056）。亚组分析显示，年龄、性别、教育水平和慢性疾病状态与心血管疾病风险的相关性存在显著异质性。中介分析显示，CMI通过抑郁症状对CVD的间接影响较小（ACME: -0.00186, 95 % CI: -0.00410-0.00），而抑郁症状通过CMI对CVD的间接影响显著（ACME: -0.00108, 95 % CI: -0.00243 -0.00）。结论：抑郁症和CMI均与CVD的风险有显著相关性。此外，当这两种因素同时存在时，发生心血管疾病的可能性明显更高。该中介分析提示抑郁症通过代谢异常调节CVD风险，为进一步病理机制研究和综合干预策略提供重要依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.