Allostatic load, depressive symptoms, and risk of cardiometabolic multimorbidity: A national representative cohort study

BACKGROUND: Chronic stress and depressive symptoms (DepS) increase the risk of cardiometabolic diseases (CMDs). However, the association of allostatic load (AL), an indicator of chronic stress burden, and DepS with cardiometabolic multimorbidity (CMM) remains unclear. This study aimed to investigate the independent and joint associations of AL and DepS with CMM. METHODS: This study included 4989 participants from the China Health and Retirement Longitudinal Study. AL was assessed based on 11 biomarkers, and DepS were evaluated using scores on the Centre for Epidemiological Studies Depression Scale. CMM was defined as the coexistence of at least two CMDs, including diabetes, heart disease, and stroke. Multivariable Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for the independent and joint associations of AL and DepS with CMDs and CMM. RESULTS: With a median follow-up of 9.0 years, 625 participants (12.53 %) developed diabetes, 932 (18.68 %) had heart disease, 413 (8.28 %) had stroke, and 333 participants (6.67 %) subsequently developed CMM. After adjusting for potential confounders, AL and DepS were associated with an increased risk of CMM (HR: 3.22, 2.39-4.33 for high AL; and HR: 1.82, 1.39-2.37 for DepS). Furthermore, participants with both high AL and DepS had the highest risk of developing CMM (HR: 4.98, 95 % CI: 3.20-7.75). CONCLUSIONS: The independent and joint effects of AL and DepS were associated with an increased risk of CMM. These findings highlight the importance of prioritizing populations with chronic stress and DepS in primary and secondary prevention of CMM.