Depressive symptom profiles and risk of cardiometabolic disease incidence

Introduction Major depressive disorder (MDD) has been linked to increased incidence of cardiometabolic disease (CMD). Depressive symptom profiles associated with inflammation (atypical energy-related symptoms (AES), anhedonia) may carry specific cardiometabolic risk. We investigated whether MDD, AES and anhedonia are associated with higher CMD incidence compared to typical depressive symptoms and control participants.Methods Data were from the Netherlands Study of Depression and Anxiety (NESDA), including participants with lifetime MDD and non-depressed controls, without baseline CMD (N = 1858). CMD incidence was established over 15-year follow-up using self-report, medication use, and glucose. AES, anhedonia, typical symptoms, and depression severity were derived from the Inventory of Depressive Symptomatology Self-Report. Cox proportional hazard models were adjusted for sociodemographic and lifestyle factors.Results CMD incidence rate was 21.3/1000 person years. MDD was associated with increased CMD incidence compared to controls (HR = 1.65, 95%CI: 1.30-2.11). In continuous analyses, only AES and depression severity were significantly associated with CMD incidence, though effect sizes were comparable across symptom profiles. When divided into severity tertiles and compared to controls, associations were largely similar across profiles, with no clear dose-response pattern. All profiles were associated with cardiovascular disease incidence, but only AES was associated with diabetes incidence.Discussion MDD is associated with CMD incidence over 15 years. Depressive symptom profiles did not show differential associations with CMD incidence. Effect sizes across profiles were comparable, suggesting a general rather than symptom-specific depression burden on cardiometabolic health risk. Continued monitoring of cardiometabolic risk factors is warranted for people with a history of depression.