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

Dongzhi Hong1, Bin Xi2, Nannan Li1

  • 1The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China.

Journal of Affective Disorders
|December 27, 2025
PubMed

Insights

Chronic stress, indicated by allostatic load (AL), and depressive symptoms (DepS) significantly increase the risk of cardiometabolic multimorbidity (CMM). Individuals with both conditions face the highest risk, emphasizing the need for targeted prevention strategies.

Area of Science:

  • Cardiology
  • Psychiatry
  • Public Health

Background:

  • Chronic stress and depressive symptoms (DepS) are known risk factors for cardiometabolic diseases (CMDs).
  • The combined impact of allostatic load (AL), a measure of chronic stress, and DepS on cardiometabolic multimorbidity (CMM) requires further investigation.

Purpose of the Study:

  • To examine the independent and joint associations of AL and DepS with the risk of developing CMM.
  • To identify individuals at higher risk for CMM based on stress and depressive symptom levels.

Main Methods:

  • Utilized data from 4989 participants in the China Health and Retirement Longitudinal Study.
  • Assessed AL via 11 biomarkers and DepS using the Centre for Epidemiological Studies Depression Scale.
  • Employed multivariable Cox proportional hazards models to analyze associations with CMM over a median 9.0-year follow-up.

Main Results:

  • High AL was independently associated with a 3.22-fold increased risk of CMM.
  • DepS were independently associated with a 1.82-fold increased risk of CMM.
  • The combination of high AL and DepS yielded the highest risk, with a 4.98-fold increased likelihood of developing CMM.

Conclusions:

  • Both allostatic load and depressive symptoms independently elevate the risk of cardiometabolic multimorbidity.
  • The synergistic effect of high AL and DepS significantly amplifies CMM risk.
  • Prioritizing individuals with chronic stress and depressive symptoms is crucial for CMM prevention efforts.
Abstract

Keywords:
Allostatic loadCHARLSCardiometabolic diseasesCardiometabolic multimorbidityDepressive symptoms

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