Cardiometabolic diseases and dynamic transitions of neuropsychiatric disorders: A longitudinal trajectory analysis

The associations of cardiometabolic diseases (CMDs) on the incidence of neurological and psychiatric disorders (NPDs) and progression to neuropsychiatric multimorbidity (NPM) and subsequent death are unclear. We aimed to evaluate the associations between CMDs and dynamic transitions of NPDs.

This prospective cohort study included 402 950 participants from the UK Biobank. NPM was defined as the coexistence of at least two NPDs (dementia, Parkinson disease, anxiety, depression and sleep disorders). A multi-state model was used to explore the association between CMDs (type 2 diabetes, hypertension, ischaemic heart disease and stroke) and the progression trajectory of NPDs.

During a median follow-up of 14.1 years, 43 359 participants developed at least one NPD, 9087 developed NPM and 31 307 died. CMDs were significantly associated with different stages of NPD progression. The hazard ratios (95% confidence intervals) per additional CMD were 1.28 (1.26, 1.29) and 1.07 (1.04, 1.10) for transitions from healthy to first neuropsychiatric disease (FNPD), and from FNPD to NPM, and 1.38 (1.36, 1.40), 1.19 (1.16, 1.23) and 1.19 (1.13, 1.25) for death from healthy, FNPD and NPM respectively. When dividing FNPD into individual NPDs, the associations of single and combined CMDs with NPD transitions varied depending on disease types and specific combinations of CMDs, even within the same transition stage. Results from the China Health and Retirement Longitudinal Study cohort confirmed the associations between CMDs and NPDs.

CMDs could play important roles in basically all transitions of NPD progression, highlighting the significance of CMD management for the prevention and control of NPDs.