The Impact of Cardiovascular-Kidney-Metabolic Syndrome Staging on Depression Risk: A National Study

Cardiovascular-kidney-metabolic (CKM) syndrome, recently defined by the American Heart Association, encompasses cardiovascular disease, chronic kidney disease, and metabolic disorders. However, its association with depression across different stages remains unclear.

We analysed 4,097 adults from National Health and Nutrition Examination Survey 2005-2020. Depression was assessed using the Patient Health Questionnaire-9, and CKM stages were classified according to the 2023 American Heart Association guidelines. Survey-weighted multivariable logistic regression was used to examine associations, with subgroup and sensitivity analyses.

The odds of depression increased progressively with CKM severity, with the highest risk observed in Stage 4 (odds ratio [OR] 1.112; 95% confidence interval [CI] 1.039-1.190; p=0.003). Significant associations were also found in Stages 2 and 3. Subgroup analyses revealed stronger associations in females (OR 1.180; 95% CI 1.053-1.322; p=0.005), older adults (OR 1.125; 95% CI 1.081-1.171; p<0.001), Mexican Americans (OR 1.260; 95% CI 1.118-1.419; p<0.001), and individuals with low education (OR 1.463; 95% CI 1.302-1.644; p<0.001).

Advancing CKM stage is significantly associated with increased depression risk, particularly among vulnerable sociodemographic groups. These findings highlight the need for integrated mental health strategies in managing CKM syndrome.