Clinical Focus ›› 2026, Vol. 41 ›› Issue (1): 18-23.doi: 10.3969/j.issn.1004-583X.2026.01.003

• Original article • Previous Articles     Next Articles

Depression and risk of incident cardiovascular disease in middle-aged and older adults with CKM stages 0-3: A 7-year retrospective cohort study

Wen Guixian1,2a,3, Zhao Shixia2b, Zhang Feifei2a,3, Xu Xingchen1,2a,3, Liu Huiliang2a,3()   

  1. 1. Graduate School of Hebei Medical University, Shijiazhuang 050017, China
    2. a.Department of Cardiology; b.Physical Examination Center, Hebei General Hospital Shijiazhuang 050051 China
    3. Hebei Key Laboratory of Precision Medicine Translational Research On Cardiovascular Diseases, Shijiazhuang 050051, China
  • Received:2025-11-05 Online:2026-01-20 Published:2026-02-02
  • Contact: Liu Huiliang E-mail:15030112599@163.com

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Abstract:

Objective To evaluate the association between depression and subsequent development of cardiovascular disease (CVD) in middle-aged and older adults with cardiovascular-kidney-metabolic syndrome (CKM) stages 0-3. Methods We performed a retrospective cohort analysis using data from the first wave (2011) of the China Health and Retirement Longitudinal Study. The cohort comprised 7, 912 participants with CKM stages 0-3 and no history of CVD at baseline, followed for 7 years. Participants were categorized according to incident CVD status during follow-up (incident CVD, n=1, 487; no CVD, n=6, 425). Associations between baseline depression severity and incident CVD were estimated using Cox proportional hazards models with adjustment for potential confounders. Subgroup analyses assessed the consistency of associations across strata, and restricted cubic spline modeling examined dose-response relationships between depression scores and CVD risk. Results During 7-year follow-up, 1, 487 of 7, 912 participants developed incident CVD (cumulative incidence 18.79%). The prevalence of depression among those with incident CVD was 42.7%. After multivariable adjustment, compared with participants without depression, those with mild depression (HR=1.293; 95%CI=1.144-1.462; P<0.001), moderate depression (HR=1.297; 95%CI=1.096-1.535; P=0.002), and severe depression (HR=1.864; 95%CI=1.491-2.330; P<0.001) had significantly higher risks of incident CVD. Subgroup analyses showed no significant interactions (all P for interaction >0.05), indicating stable associations across examined strata. Restricted cubic spline analysis suggested a nonlinear increase in CVD risk when depression scores exceeded 7 points in the overall CKM 0-3 cohort; sex-stratified analyses indicated that the risk increased for men at depression scores >6 and for women at scores >7. Conclusion In this large Chinese cohort of middle-aged and older adults with CKM stages 0-3, baseline depression was independently associated with a higher risk of incident CVD over seven years, with risk increasing progressively with depression severity.

Key words: cardiovascular-kidney-metabolic syndrome, cardiovascular disease, depression, middle-aged and older adults, cohort study

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