Role of depression in the development of cardiometabolic multimorbidity: Findings from the UK Biobank study

The joint effect of triglyceride-glucose related indices and depression on cardio-renal-metabolic multimorbidity among middle-aged and older Chinese adults

BACKGROUND

The triglyceride-glucose (TyG) related indices, indicators for insulin resistance, and depression are both established predictors of cardiovascular diseases. However, the single and combined effect of TyG related indices and depression on cardio-renal-metabolic multimorbidity (CRMM) risk remain uncertain.

METHODS

This study included 7848 respondents aged 45 years and older, derived from the China Health and Retirement Longitudinal Study (CHARLS) 2011, 2020. Cox regression was used to determine independent and joint effect of TyG indices and depression on CRMM incidence. Restricted cubic spline (RCS) was further performed to identify associations of TyG indices with CRMM.

RESULTS

Results demonstrated that both TyG indices (including TyG-WC, TyG-WHtR, and TyG-BMI) and depression were independently linked to increased risk of CRMM. The RCS model further confirmed the significant dose-response relationships. Participants experiencing both elevated TyG indices and depression exhibited the highest CRMM risk, in contrast to those with neither condition (HR = 1.630, 95%CI: 1.467-1.811; HR = 1.631, 95%CI: 1.465-1.817; HR = 1.582, 95%CI: 1.419-1.764; HR = 1.532, 95%CI: 1.372-1.711, respectively).

LIMITATIONS

Firstly, disease diagnoses in the CHARLS were self-reported, which might cause recall bias. Then, data was specific to the population over 45 years old, so the results may not apply broadly to all populations.

CONCLUSIONS

This study revealed both the single and joint effect of TyG, TyG-WC, TyG-WHtR, as well as TyG-BMI and depression on CRMM risk. Combined evaluations of the TyG index with depression screening is crucial for identifying related risk factors and enhancing prevention strategies against CRMM.

Association of functional disability with cardiometabolic disease status in a national cohort study

BACKGROUND

Cardiometabolic disease (CMD) status increases the risk of functional disability; however, the reverse relationship remains unclear. This study aimed to examine the impact of different patterns of functional disability on CMD status among Chinese middle-aged and older adults.

METHODS

We used data from two waves of the China Health and Retirement Longitudinal Study. Functional disability was assessed based on activities of daily living (ADL) and instrumental activities of daily living (IADL), while CMD status was evaluated based on the incidence of diabetes, heart disease, and stroke. Generalized ordinal logistic regression analysis was employed to investigate the impact of functional disability on CMD status.

RESULTS

In the longitudinal study, 509 individuals (20.0 %) developed CMD, and 102 individuals (4.0 %) developed cardiometabolic multimorbidity. After adjusting for confounders, Model 1 showed an odds ratio of 1.64 (95 % CI: 1.17, 2.29) for increased CMD status in individuals with ADL and IADL disability compared to those without functional disability. Model 2 and Model 3 produced similar results.

CONCLUSIONS

Functional disability, particularly ADL and IADL disability, increases the risk of CMD status in Chinese middle-aged and older adults. Measures should be implemented to maintain functional status in middle-aged and older adults.

Linking cardiometabolic multimorbidity to depressive symptoms in the oldest-old: results from a cross-sectional study in Germany

BACKGROUND

Depression often accompanies cardiometabolic multimorbidity (CMM), but it remains unclear whether this association persists in very old people. Hence, we examined the link between CMM and depressive symptoms in an oldest-old population.

METHODS

Using cross-sectional data from a representative sample of individuals aged 80 years and older in North Rhine-Westphalia, Germany (N = 1,863), we constructed an additive disease index covering seven cardiometabolic diseases (CMDs): myocardial infarction, heart failure, hypertension, stroke, diabetes mellitus, kidney disease, and obesity. Depressive symptoms were assessed using the short form of the Depression in Old Age Scale (0 to 4 points). We employed multivariable linear regression models to study associations of CMD index (0, 1, 2, ≥ 3 CMDs) and CMD count (0 to 7 diseases) with depressive symptoms, adjusting for age, sex, socio-economic index, respiratory and pulmonary disease, cancer, and liver disease.

RESULTS

Participants had a mean depressive symptom score of 0.94, and 44% reported two or more CMDs. Heart failure, hypertension, stroke, and obesity were each individually associated with more depressive symptoms. Participants with two (β = 0.30; 95%-CI: 0.12-0.48), and three or more CMDs (β = 0.40; 95%-CI: 0.18-0.62) showed higher depressive symptoms compared to those with no CMD, i.e., each additional CMD was associated with a 0.30-unit or 0.40-unit increase in depressive symptoms, respectively. We observed an additive dose-response association between CMD count and depressive symptoms (β = 0.16; 95%-CI: 0.09-0.23), slightly more pronounced for women (β = 0.19; 95%-CI: 0.10-0.29) than for men (β = 0.10, 95%-CI: 0.02-0.19).

CONCLUSIONS

Individuals with CMM showed increased depressive symptomatology, indicating the need to address both physical and mental health in oldest-old individuals with high CMD burden. However, the cross-sectional study design prevents conclusions about causality and warrants further longitudinal studies.

Chronic emotional stress and mediating role of Interleukine-6 in the association with cardiometabolic disorders in a multiethnic middle-aged and older US-population

Introduction

Chronic emotional stress is a well-recognized risk factor for psychiatric and cardiometabolic disorders. The mediating role of low-grade inflammation in older, ethnically diverse populations has never been studied.

Methods

The multiethnic ≥ 50-year-old study population is a subset of the Health and Aging Brain Study: Health Disparities (HABS-HD) study. Adjusted logistic and linear regression were used to assess associations. Statistical mediation analysis with non-parametric bootstrapping was used to determine the intermediate role of Interleukine-6 (IL-6).

Results

The study included 2,173 participants (50-92 years). Hispanic and Black participants disclosed higher chronic stress levels than White participants. Having a chronic stress total score ≥ six points is associated with 53% higher odds of disclosing concomitant cardiovascular disease (CVD) (adj.OR=1.53 [1.1-2.53]), 31% of Type-2 diabetes (T2DM) (adj.OR=1.31[1.06-1.62]), 23% of hypertension (adj.OR=1.23 [1.02-1.49]), and 30% obesity (adj.OR=1.3[1.09-1.55]). These associations were statistically mediated by IL-6 (12% (p-value FDR=0.012) of the association with CVD, 17% T2DM (p-value FDR<0.001), 18% hypertension (p-value FDR<0.001), and 29% obesity (p-value FDR=0.005)).

Conclusions

The study highlights a further aspect of the pathophysiological mechanisms involved in brain-body communication. While IL-6 partially explains statistical associations between chronic emotional stress and major cardiometabolic disorders, potential causal effects need to be explored in larger longitudinal studies.

Assessment and ascertainment in psychiatric molecular genetics: challenges and opportunities for cross-disorder research

Psychiatric disorders are highly comorbid, heritable, and genetically correlated [1-4]. The primary objective of cross-disorder psychiatric genetics research is to identify and characterize both the shared genetic factors that contribute to convergent disease etiologies and the unique genetic factors that distinguish between disorders [4, 5]. This information can illuminate the biological mechanisms underlying comorbid presentations of psychopathology, improve nosology and prediction of illness risk and trajectories, and aid the development of more effective and targeted interventions. In this review we discuss how estimates of comorbidity and identification of shared genetic loci between disorders can be influenced by how disorders are measured (phenotypic assessment) and the inclusion or exclusion criteria in individual genetic studies (sample ascertainment). Specifically, the depth of measurement, source of diagnosis, and time frame of disease trajectory have major implications for the clinical validity of the assessed phenotypes. Further, biases introduced in the ascertainment of both cases and controls can inflate or reduce estimates of genetic correlations. The impact of these design choices may have important implications for large meta-analyses of cohorts from diverse populations that use different forms of assessment and inclusion criteria, and subsequent cross-disorder analyses thereof. We review how assessment and ascertainment affect genetic findings in both univariate and multivariate analyses and conclude with recommendations for addressing them in future research.

Trends in prevalence and multimorbidity of metabolic, cardiovascular, and chronic kidney diseases among US adults with depression from 2005 to 2020

BACKGROUND

Comorbid depression and cardiometabolic diseases are prevalent and increase risk of mortality. However, trends in the prevalence and multimorbidity of cardiometabolic diseases in depression are unclear.

METHODS

Data of adults aged ≥20 years with depression from the National Health and Nutrition Examination Survey 2005-2020 were analyzed. Joinpoint regression analysis was used to estimate trends in the prevalence of dyslipidemia, hypertension, diabetes, chronic kidney disease, non-alcoholic fatty liver disease, and cardiovascular disease as well as having ≥3 of these diseases. Differences in the prevalence of these diseases in depression vs no depression were assessed using Poisson regressions after applying propensity score weighting.

RESULTS

A total of 3412 adults with depression were included. The prevalence of cardiometabolic diseases as well as having ≥3 diseases remained high and stable in the overall sample from 2005 to 2020 (P for trend >0.05). In 2017-2020, the prevalence ranged from 17.1 % (95 % CI, 12.7 %-21.5 %) for cardiovascular disease to 58.4 % (95 % CI, 50.4 %-66.3 %) for dyslipidemia; 40.7 % (95 % CI, 34.4 %-46.9 %) had ≥3 diseases. The prevalence of diabetes, cardiovascular disease, and having≥3 diseases was 23 %-85 % higher in adults with depression than those without.

LIMITATIONS

The utilization of self-reported data and/or one-time laboratory measurements may misclassify participants.

CONCLUSIONS

Prevalence of cardiometabolic diseases was high and multimorbidity was common in US adults with depression. Addressing the prevention, treatment, and management of cardiometabolic diseases in depression requires greater public health and clinical attention.

Burden of cardiometabolic diseases and depression in a low-income, urban community in Pakistan: a cross-sectional survey

BACKGROUND

With the rising epidemic of cardiometabolic diseases (CMDs) in low- and middle-income countries, urban populations face unique challenges such as poor sanitation, environmental pollution, and limited access to healthcare. This study estimates the point prevalence of CMDs and associated risk factors in adults in Karachi, analyses CMD prevalence by sex, and explores the relationship between CMDs and depression.

METHODS

A door-to-door survey was conducted in a densely populated urban community within a 0.5 km radius of a primary health centre. A minimum of 1,480 families were required to estimate the prevalence of CMDs. Depression was screened using PHQ-2 and assessed with PHQ-9. Descriptive analyses summarized family-level sociodemographic data. Sex-specific differences in CMD-related risk factors were analysed using χ2 and t-tests. Point prevalence and 95% confidence intervals (CIs) for CMDs were calculated. Bivariate analyses compared cardiometabolic risk factors, healthcare utilization, and mental health across CMD categories. Logistic regression assessed associations between CMDs, demographics, risk factors, and depression.

RESULTS

Of the 1,513 families that participated, 3051 adults were included in the analyses. In this stable community (60% residing for more than five years), there was high Urdu (91%) and English (76%) literacy. There was high cell phone ownership (90%) and internet use (81%). Hypertension was the most prevalent CMD (34%). The likelihood of CMD increased with age, rising 49.39 times (95% CI: 30.21 - 80.74; p: < 0.001) higher in those 60 years and above than those aged 18-29. CMD prevalence was strongly associated with depression, compared to those with no CMDs, there were significantly higher odds of mild (OR: 1.89; 95% CI: 1.28 - 2.78; p: < 0.001) and moderate (OR: 2.21; 95%CI: 1.17 - 4.17; p: < 0.014) depression among participants with CMDs. Median health expenditure was 14.2% (IQR: 11.4-26.7%) of monthly income, with increasing CMD burden linked to higher rates of delay in purchasing medications (p: < 0.001).

CONCLUSION

This study highlights the significant burden of CMDs, multimorbidity, and depression in a low-income urban community in Pakistan. The findings suggest that a cardiometabolic multimorbidity (CMM) epidemic is emerging in urban Pakistan, emphasizing the need for integrated interventions addressing physical, mental, economic, and environmental factors in CMD management.

Depression and physical multimorbidity: A cohort study of physical health condition accrual in UK Biobank

BACKGROUND

Depression is associated with a range of adverse physical health outcomes. We aimed to quantify the association between depression and the subsequent rate of accrual of long-term physical health conditions in middle and older age.

METHODS AND FINDINGS

We included 172,556 participants from the UK Biobank (UKB) cohort study, aged 40-71 years old at baseline assessment (2006-2010), who had linked primary care data available. Using self-report, primary care, hospital admission, cancer registry, and death records, we ascertained 69 long-term physical health conditions at both UKB baseline assessment and during a mean follow-up of 6.9 years. We used quasi-Poisson models to estimate associations between history of depression at baseline and subsequent rate of physical condition accrual. Within our cohort, 30,770 (17.8%) had a history of depression. Compared to those without depression, participants with depression had more physical conditions at baseline (mean 2.9 [SD 2.3] versus 2.1 [SD 1.9]) and accrued additional physical conditions at a faster rate (mean 0.20 versus 0.16 additional conditions/year during follow-up). After adjustment for age and sex, participants with depression accrued physical morbidities at a faster rate than those without depression (RR 1.32, 95% confidence interval [CI] [1.31, 1.34]). After adjustment for all sociodemographic characteristics, the rate of condition accrual remained higher in those with versus without depression (RR 1.30, 95% CI [1.28, 1.32]). This association attenuated but remained statistically significant after additional adjustment for baseline condition count and social/lifestyle factors (RR 1.10, 95% CI [1.09, 1.12]). The main limitation of this study is healthy volunteer selection bias, which may limit generalisability of findings to the wider population.

CONCLUSIONS

Middle-aged and older adults with a history of depression have more long-term physical health conditions at baseline and accrue additional physical conditions at a faster rate than those without a history of depression. Our findings highlight the importance of integrated approaches to managing both mental and physical health outcomes.

Association between major depressive disorder or depressive symptoms and the risk of vascular complications among patients with type 2 diabetes, and the mediating role of metabolic biomarkers: an analysis of the UK Biobank cohort

Background

Depression is a severe mental disorder commonly co-morbid with diabetes, but it remains to elucidate whether depression is associated with the risks of a wide range of vascular complications in people with type 2 diabetes mellitus (T2DM) and whether metabolic biomarkers may mediate this pathway.

Methods

We conducted this prospective analysis among the participants of the UK Biobank who were diagnosed with T2DM and free of vascular complications at baseline between March 13, 2006 and September 30, 2010. Major depressive disorder (MDD) was ascertained according to the hospital admission records and self-report of doctor-diagnosed conditions, while the presence of depressive symptoms was assessed using the Patient Health Questionnaire-2. Cox proportional hazards models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MDD and depressive symptoms with the risks of incident heart failure (HF); total and individual atherosclerotic cardiovascular disease (ASCVD) including coronary artery disease (CAD), ischemic stroke (IS), and peripheral artery disease (PAD); total and individual microvascular complications of diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic neuropathy (DN). Mediation analyses were conducted to quantify the potential mediation effects of circulating metabolites (involved in insulin-resistance, lipid profile, liver function, renal function, and inflammation) in the association of MDD with the outcomes.

Findings

Of the total 23,856 patients with T2DM in the UK Biobank, 13,706 participants (61% males) were eligible and included in this study. During an average of 13 years of follow-up, 2927 (21.36%) ASCVD, 1070 (7.81%) HF, and 2579 (18.82%) microvascular complications occurred. The adjusted HR (95% CI) for MDD was 1.32 (1.09-1.61) with HF, 1.17 (1.03-1.32) with ASCVD, and 1.29 (1.14-1.46) with microvascular complications, while those for depressive symptoms were 1.47 (1.20-1.79), 1.25 (1.10-1.42) and 1.20 (1.05-1.37), respectively. The HRs ranged from 1.26 (1.09-1.44) to 1.96 (1.57-2.45) for MDD with individual complications and mortality, and from 1.26 (1.08-1.47) to 1.49 (1.16-1.93) for depressive symptoms. Up to 7.8% of adverse complications were attributable to MDD and 3.8% to depressive symptoms. A series of circulating metabolites involving lipid profile, renal function, and inflammation were observed to mediate the associations of MDD with vascular complications. The identified mediators jointly accounted for 7.29%-26.87% of the disparities in incident vascular complications between patients with and without MDD.

Interpretation

Our findings highlight the role of MDD and depressive symptoms in the development of vascular complications among people with T2DM, and suggest that the effect of improving mental health on vascular outcomes in patients with T2DM should be investigated in future work.

Funding

Three-Year Public Health Action Plan of Shanghai.

Functional dependency and cardiometabolic multimorbidity in older people: pooled analysis of individual-level data from 20 countries

BACKGROUND

The impact of cardiometabolic multimorbidity (CMM) on functional dependency (FD) is well established, but the temporal effect of FD on CMM and its mechanisms remain underexplored.

DESIGN

A multicohort study pooled data from three international cohorts.

SETTING

Data were sourced from the Health and Retirement Study (USA), the China Health and Retirement Longitudinal Study (China) and the Survey of Health, Ageing and Retirement in 18 European countries.

METHODS

FD was defined as the inability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs) independently. CMM was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease and stroke. Generalised estimating equation models assessed associations between FD and CMM, with mediation analysis using the Karlson, Holm and Breen method to explore the effects of hypertension and depressive symptoms. Sensitivity analyses ensured robustness.

RESULTS

The final cohort included 157 512 and 190 249 individuals for ADL and IADL analyses, respectively. CMM prevalence was 18.97% and 16.65% in these groups. FD was consistently associated with higher CMM risk, with odds ratios ranging from 1.47 (95% confidence interval: 1.33-1.63) to 1.56 (1.42-1.73). Hypertension and depressive symptoms increased CMM risk, particularly at higher FD levels. Mediation analysis showed hypertension and depressive symptoms accounted for 8.01%-16.43% and 12.04%-18.36% of the adverse effect of FD on CMM, respectively, with more pronounced effects among smokers and heavy drinkers.

CONCLUSIONS

Targeted interventions focusing on hypertension, mental wellness, lifestyle factors, and integrated treatments for FD are crucial to prevent CMM in older adults.

Gestational diabetes mellitus, body mass index, and cardiometabolic multimorbidity: A prospective cohort study

PURPOSE

Gestational diabetes mellitus (GDM) could increase the risks of type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, evidence on its association with cardiometabolic multimorbidity (CMM) was limited. This study aimed to evaluate the association between GDM and the prevalence, incidence, patterns, and progression of CMM; and the role of body mass index (BMI) in such association.

METHODS

This study included 203,372 women who have given birth in UK Biobank. The diagnoses of GDM and cardiometabolic diseases (including stroke, coronary heart disease [CHD], and T2DM) were reported by participants or obtained through linkage to inpatient hospital data until 31st December 2020. BMI was assessed at the baseline assessment. CMM was defined as having two or more of included cardiometabolic diseases. Logistic regression models and Cox proportional hazard models were used to assess the association between GDM and CMM, and the modifications on both additive and multiplicative scales were assessed to evaluate the effect of BMI on such association.

RESULTS

A total of 1217 women had a history of GDM, 2351 participants had CMM at the end of follow-up and 1601 was newly diagnosed during follow-up. GDM was associated with higher prevalence (odds ratio [OR]=4.64, 95 % confidence interval [95 % CI]=3.54-6.08) and incidence (hazard ratio [HR]=3.62, 95 % CI=2.62-5.00) of CMM. In particular, GDM was associated with higher odds of T2DM, coexisting T2DM and vascular disease, and T2DM followed by vascular disease. Formal testing for effect modification suggested multiplicative modification by BMI for the association between GDM and incident CMM.

CONCLUSIONS

GDM was associated with CMM in women's late life, with multiplicative modification effects of BMI. Our results suggest that maternal and lifestyle interventions (e.g., weight management) are warranted for the primary and secondary prevention of CMM, particularly in women with a history of GDM.

Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic

Background

Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical.

Methods

Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.

Findings

Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = -0.207, 95% CI = (-0.255, -0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = -0.040, 95% CI = (-0.047, -0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies.

Interpretation

Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness.

Funding

Natural Science Foundation of China and National Institute on Aging/National Institutes of Health.

Bidirectional Associations Between Cardiometabolic Multimorbidity and Depression and Mediation of Lifestyles: A Multicohort Study

Background

Cardiometabolic multimorbidity (CMM) and depression are major health concerns, and the onset of either condition may heighten the risk of developing the other.

Objectives

The goal of this study was to characterize the reciprocal associations between CMM and depression among middle-aged and older adults.

Methods

This multicohort study used harmonized data from 5 prospective cohorts from China, South Korea, the United States, the United Kingdom, and Europe. Cardiometabolic diseases (CMDs) (including diabetes, heart diseases, and stroke) and depression were assessed at baseline and at 7 to 8 years' follow-up. Lifestyle factors, including physical activity, alcohol consumption, and smoking status, were regarded as potential mediators. Two sets of analyses, CMM-depression analyses (n = 67,188) and depression-CMM analyses (n = 65,738), were conducted to explore the bidirectional associations between CMM and depression.

Results

In the CMM-depression analyses, 16,596 (24.7%) individuals developed depression. Participants with a single CMD (HR: 1.24; 95% CI:1.19-1.29) and CMM (HR: 1.52; 95% CI: 1.42-1.63) at baseline had higher risks of depression occurring. Physical activity and alcohol consumption significantly mediated 7.5% and 6.9% of the CMM-depression association, respectively. In the depression-CMM analyses, 1,461 (2.2%) participants developed CMM. The HR for developing CMM was 1.31 (95% CI: 1.14-1.50) in patients with depression, with increased risk of developing more CMDs. Physical activity and alcohol consumption mediated 12.0% and 7.1% of the depression-CMM association. The bidirectional relationships were more pronounced in Western countries than in Asian countries.

Conclusions

CMM and depression were bidirectionally associated. The mediated effects of lifestyle factors were larger in the depression-lifestyle-CMM pathway than in the CMM-lifestyle-depression pathway.

Combined influence of depression symptoms and ratio of triglyceride to high-density lipoprotein cholesterol on cardiometabolic multimorbidity: Findings from the China Health and Retirement Longitudinal Study 2011-2018

BACKGROUND

Previous studies had reported depression symptoms and TG/HDLC ratio may share pathophysiological pathway. The aim was to investigate the combined effects of depression symptoms and TG/HDL-C ratio on the risk of CMM.

METHODS

This cohort study extracted data from 2011 to 2018 of CHARLS. The CMM event occurred from 2013 to 2018, defined as suffering from more than one of stroke, cardiac events, and diabetes mellitus. Cox proportional hazards regression models were used to assess the association between the baseline combined effects of depression symptoms and TG/HDL-C ratio with incidence of CMM, stroke, cardiac events, and diabetes mellitus.

RESULTS

A total of 8349 participants (3966 men and 4383 women) were included in the study, with a mean age of 58.5 years. During a 7-year follow-up survey, 370 (4.43 %) participants developed CMM. Compared to individuals with no depression symptoms and low TG/HDLC ratio, the multivariable-adjusted HRs (95%CI) for the new-onset CMM for patients with the depression symptoms alone, high TG/HDLC ratio alone, and depression symptoms and high TG/HDLC ratio were 1.37 (95 % CI = 0.95-1.98), 1.62 (95 % CI = 1.22-2.14), 1.94 (95 % CI = 1.39-2.72), respectively (P < 0.001).

LIMITATIONS

Firstly, potential confounding factors such as dietary intake and nutrition were not collected at the time of study design. Secondly, exposure to the outcome was self-reported, which may cause recall bias or misclassification. Finally, the population was aged ≥45 years, so the results cannot be generalized to all age groups.

CONCLUSION

Our findings indicated that patients with depression and high TG/HDLC ratio had a higher risk of developing CMM.

Association of Visceral Adiposity Index and Handgrip Strength with Cardiometabolic Multimorbidity among Middle-Aged and Older Adults: Findings from Charls 2011-2020

The visceral adiposity index (VAI) and handgrip strength (HGS) are identified as important objectives for the prevention of illness. Nevertheless, there is limited understanding regarding the impact of the VAI and HGS on cardiometabolic multimorbidity (CMM). We aimed to ascertain the impact of the VAI and HGS on CMM among middle-aged and older people. Data spanning from 2011 to 2020 were derived from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7909 individuals aged 45 years and older were included. Cox proportional hazard regression was utilized to examine the correlation among the VAI, HGS, and CMM. Throughout the 10-year follow-up, we determined that both the VAI (HR = 1.330; 95%CI = 1.179-1.500) and HGS (HR = 0.745, 95%CI = 0.645-0.861) exhibited significant associations with CMM risk. Individuals exposed to both a high VAI and low HGS were found to have higher hazards of CMM (HR = 1.377, 95%CI = 1.120-1.694) in contrast to participants exposed to one or none of these conditions. The older (HR = 1.414; 95%CI = 1.053-1.899) and male (HR = 1.586; 95%CI = 1.114-2.256) groups are more likely to experience CMM risk. Our findings suggest that both the VAI and HGS have significant effects on CMM risk. Appropriate interventions focused on vulnerable groups are recommended to prevent the incidence of CMM.

Association between chronic pain and risk of cardiometabolic multimorbidity: a prospective cohort study

BACKGROUND

Although chronic pain was deleteriously related to single cardiometabolic diseases, the relationship between chronic pain and cardiometabolic multimorbidity remains unclear. The purpose of this study was to investigate the association between chronic pain with the risk of cardiometabolic multimorbidity.

METHODS

A prospective cohort study included 452 818 participants who were free of cardiometabolic multimorbidity at baseline. Chronic pain was assessed in diverse anatomical sites including the head, face, neck/shoulder, stomach/abdominal area, back, hip and knee or 'all over the body'. Participants were classified into six groups according to the amount of chronic pain sites: no chronic pain, chronic pain at one, two, three and four or more sites, and those reporting pain 'all over the body'. Cardiometabolic multimorbidity was defined as the occurrence of at least two cardiometabolic diseases, involving type 2 diabetes, ischaemic heart disease and stroke.

RESULTS

After a median follow-up of 13.7 years, 4445 participants developed cardiometabolic multimorbidity. Compared with individuals without chronic pain, those experiencing chronic pain in four or more sites were associated with a 1.82-fold (HR: 1.82, 95% CI: 1.61, 2.06) higher risk of cardiometabolic multimorbidity. Pain distributed 'all over the body' was associated with a 59% (HR: 1.59, 95% CI: 1.30, 1.93) increased risk of cardiometabolic multimorbidity Additionally, individuals who had chronic pain in both the head and stomach/abdomen showed the highest risk with cardiometabolic multimorbidity (HR: 1.88, 95% CI: 1.60, 2.20).

CONCLUSIONS

Our findings suggested that there was an elevated risk of cardiometabolic multimorbidity associated with an increased amount of chronic pain sites.

Genome-wide association study of cardiometabolic multimorbidity in the UK Biobank

Considering the high prevalence and poor prognosis of cardiometabolic multimorbidity (CMM), identifying causal factors and actively implementing preventive measures is crucial. However, Mendelian randomization (MR), a key method for identifying the causal factors of CMM, requires knowledge of the effects of SNPs on CMM, which remain unknown. We first analyzed the genetic overlap of single cardiometabolic diseases (CMDs) using the latest genome-wide association study (GWAS) for evidential support and comparison. We observed strong positive genetic correlations and shared loci among all CMDs. Further, GWAS and post-GWAS analyses of CMM were performed in 407 949 European ancestry individuals from the UK Biobank. Eleven loci and 12 lead SNPs were identified. By comparison, we found these SNPs were a subset of SNPs associated with CMDs, including both shared and non-shared SNPs. Then, the polygenic risk score model predicted the risk of CMM (C-index = 0.62) and we identified candidate genes related to lipid metabolism and immune function. Finally, as an example, two-sample MR analysis based on the GWAS revealed potential causal effects of total cholesterol, serum urate, body mass index, and smoking on CMM. These results provide a basis for future MR research and inspire future studies on the mechanism and prevention of CMM.

Quantifying depressive symptoms on incidence of common chronic diseases and multimorbidity patterns in middle-aged and elderly Chinese adults

BACKGROUND

Depressive symptoms are highly prevalent and increase risks of various morbidities. However, the extent to which depressive symptoms could account for incidence of these chronic conditions, in particular multimorbidity patterns, remains to be examined and quantified.

METHODS

For this cohort analysis, we included 9024-14,093 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the longitudinal associations between depressive symptoms and 13 common chronic diseases and 4 multimorbidity patterns. Population attributable fractions (PAFs) combining the information on both exposure prevalence and risk association were estimated to quantify the magnitude of the burden of these conditions attributable to depressive symptoms.

RESULTS

Depressive symptoms were associated with increased risks of liver disease, stroke, heart problem, asthma, diabetes, arthritis, kidney disease, chronic lung disease, digestive disease, dyslipidemia, and memory-related disease, and the adjusted HRs (95% CIs) and PAFs (95% CIs) ranged from 1.15 (1.05-1.26) to 1.64 (1.38-1.96) and 5% (0-10%) to 17% (6-28%), respectively. In addition, individuals with depressive symptoms had elevated risks of the cardiometabolic-cancer pattern, the cerebrovascular-memory pattern, the articular-visceral organ pattern, and the respiratory pattern, with respective HRs (95% CIs) of 1.26 (1.11-1.42), 1.34 (1.07-1.69), 1.45 (1.29-1.63), and 2.01 (1.36-2.96), and respective PAFs (95% CIs) of 5% (0-10%), 8% (-4-21%), 12% (7-17%), and 20% (5-35%).

CONCLUSION

Depressive symptoms contribute substantially to the burden across a broad range of chronic diseases as well as different multimorbidity patterns in middle-aged and older Chinese.

Gender-specific association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms

BACKGROUND

In the era of rapid aging with a rising prevalence of multimorbidity, complex interactions between physical and psychological conditions have challenged the health care system. However, little is known about the association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms, especially in developed countries.

METHODS

This population-based cohort study used data from the Health and Retirement Study. A total of 22,335 middle-aged and older adults participated in the 2014 (T1), 2016 (T2), and 2018 (T3) waves of the cohort were included. The accumulation of chronic conditions and disability were defined as the number of chronic diseases and the five activities of daily living. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. A longitudinal mediation model with a cross-lagged panel model was run. As robust check, the models were applied with a longer follow-up period (from 2012 to 2018). Additionally, results were estimated in China.

RESULTS

Bidirectional associations have been found among the accumulation of chronic conditions, disability, and depressive symptoms, especially between disability and depression. Disability (T2) mediated 11.11 % and 16.87 % of the association between the accumulation of chronic conditions (T1) and depression (T3) for men and women in the United States. The results were consistent in robust analysis.

CONCLUSIONS

This study found that men and women routinely experienced disability and depressive symptoms because of the accumulation of chronic conditions. In terms of depressive symptoms, women were more sensitive to the accumulation of chronic conditions through disability.

Variations in sociodemographic and health-related factors are linked to distinct clusters of individuals with depression based on the PHQ-9 instrument: NHANES 2007-2018

BACKGROUND

Depression is a heterogeneous disease. Identification of latent depression subgroups and differential associations across these putative groups and sociodemographic and health-related factors might pave the way toward targeted treatment of individuals.

METHODS

We used model-based clustering to identify relevant subgroups of 2900 individuals with moderate to severe depression (defined as scores ≥10 on the PHQ-9 instrument) from the NHANES cross-sectional survey. We used ANOVA and chi-squared tests to assess associations between cluster membership and sociodemographics, health-related variables, and prescription medication use.

RESULTS

We identified six latent clusters of individuals, three based on depression severity and three differentially loaded by somatic and mental components of the PHQ-9. The Severe mental depression cluster had the most individuals with low education and income (P < 0.05). We observed differences in the prevalence of numerous health conditions, with the Severe mental depression cluster showing the worst overall physical health. We observed marked differences between the clusters regarding prescription medication use: the Severe mental depression cluster had the highest use of cardiovascular and metabolic agents, while the Uniform severe depression cluster showed the highest use of central nervous system and psychotherapeutic agents.

LIMITATIONS

Due to the cross-sectional design we cannot make conclusions about causal relationships. We used self-reported data. We did not have access to a replication cohort.

CONCLUSIONS

We show that socioeconomic factors, somatic diseases, and prescription medication use are differentially associated with distinct and clinically relevant clusters of individuals with moderate to severe depression.

Depressive symptoms and risk of incident cardiometabolic multimorbidity in community-dwelling older adults: The China Health and Retirement Longitudinal Study

BACKGROUND

Depressive symptoms are associated with an increased risk of developing cardiometabolic diseases (CMDs). However, the relationship between depressive symptoms and cardiometabolic multimorbidity (CMM) remains unclear. Therefore, we aimed to examine whether depressive symptoms were associated with an increased risk of incident CMM in middle-aged and older Chinese adults.

METHODS

This prospective cohort study included 6663 participants who were free of CMM at baseline from the China Health and Retirement Longitudinal Study. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10). Incident CMM refers to the coexistence of ≥2 CMDs (heart disease, stroke, or diabetes). Multivariable logistic regressions and restricted cubic splines were performed to assess the association between depressive symptoms and incident CMM.

RESULTS

The median CESD-10 score at baseline was 7 (IQR: 3 to 12). Over 4 years of follow-up, 309 participants (4.6 %) developed CMM. After adjusting for sociodemographic, behavioral, and traditional clinical risk factors, a higher frequency of depressive symptoms was associated with an increased risk of incident CMM (per 9-point higher CESD-10 score OR: 1.73; 95 % CI: 1.48-2.03). The association between the CESD-10 score and incident CMM was more obvious in women (OR: 2.02; 95 % CI: 1.63-2.51) than in men (OR: 1.16; 95 % CI: 0.86-1.56) (P_interaction = 0.005).

LIMITATIONS

Heart diseases and stroke were determined based on self-reported physician diagnoses.

CONCLUSIONS

A higher frequency of depressive symptoms at baseline increased the risk of incident CMM within four years among middle-aged and older individuals in China.

Association of comorbid depression and obesity with cardiometabolic multimorbidity among middle-aged and older Chinese adults: A cohort study

PURPOSE

To evaluate the association of comorbid depression and obesity with the risk of incident cardiometabolic multimorbidity among middle-aged and older Chinese adults.

METHODS

This cohort study extracted data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). Depression was confirmed by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) with a cut-off score ≥10. Obesity was defined as a body mass index ≥28 kg/m². Participants were categorized into four groups based on depression and obesity status at baseline, i.e., with neither condition, depression only, obesity only, and with both conditions. Cardiometabolic multimorbidity was defined as the coexistence of two or more of heart diseases, stroke, and diabetes mellitus. Logistic regression models were established to estimate the associations.

RESULTS

A total of 9,308 participants without cardiometabolic multimorbidity at baseline were included (mean [SD] age, 58.8 [9.0] years; 4,449 [47.8%] were males). During four-year of follow-up, 349 (3.8%) participants developed cardiometabolic multimorbidity. Compared to participants without depression or obesity, comorbid depression and obesity was associated with greater risk of cardiometabolic multimorbidity (adjusted OR: 4.79, 95% CI: 3.09-7.43) than that in participants with depression alone (adjusted OR: 1.84, 95% CI: 1.37-2.46) or obesity alone (adjusted OR: 2.26, 95% CI: 1.48-3.45). The findings were consistent in different gender and age groups.

CONCLUSIONS

Comorbid depression and obesity was associated with excessive risk of cardiometabolic multimorbidity. Intervention targeting at individuals with both depression and obesity might have substantial benefit in minimizing the risk of cardiometabolic multimorbidity.