Depression and Human Immunodeficiency Virus Infection Are Risk Factors for Incident Heart Failure Among Veterans Veterans Aging Cohort Study
Depression and Human Immunodeficiency Virus Infection Are Risk Factors for Incident Heart Failure Among Veterans Veterans Aging Cohort Study
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DOI：
10.1161/circulationaha.114.014443
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发表时间：
2015-10-27
期刊：
影响因子：
37.8
通讯作者：
Freiberg, Matthew S.
中科院分区：
文献类型：
--
作者：
White, Jessica R.;Chang, Chung-Chou H.;Freiberg, Matthew S.
背景-HIV和抑郁症都与心力衰竭（HF）风险增加有关。抑郁症是一种常见的合并症，可能会进一步增加HIV感染（HIV+）成人的HF风险。我们评估了HIV、抑郁症和HF事件之间的关系。方法和结果--退伍军人老龄队列研究（VACS）参与者在基线时无心血管疾病（n=81 427：26 908例HIV+，54 519例无HIV [HIV-]）分为4组：HIV-无重度抑郁症（MDD）[参考]，HIV-伴MDD，HIV+无MDD，HIV+伴MDD。使用来自病历的国际疾病分类第九版代码确定MDD和主要结局HF。经过5.8年的随访，每1000人-年的HF发生率在患有MDD的HIV+参与者中最高（9.32; 95%置信区间[CI]，8.20-10.6）。在考克斯比例风险模型中，与无MDD的HIV-受试者相比，HIV+ MDD受试者发生HF的风险显著更高（校正风险比，1.68; 95% CI，1.45-1.95）。在HIV-和HIV+受试者的单独完全校正模型中，MDD与HF相关（分别为校正风险比，1.21; 95% CI，1.06-1.37;校正风险比，1.29; 95% CI，1.11-1.51）。在患有重度抑郁症的患者中，基线抗抑郁药的使用与发生心力衰竭事件的风险较低相关（调整后的风险比，0.76; 95%CI，0.58-0.99）。结论-我们的研究是第一个表明重度抑郁症是HIV+成人心力衰竭的独立危险因素。这些结果加强了识别和管理HIV+患者中MDD的重要性。未来的研究必须阐明HIV、MDD、抗抑郁药和HF之间的联系机制，并确定降低HIV和MDD患者HF发病率和死亡率的干预措施。
Background-Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF.Methods and Results-Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV-]) were categorized into 4 groups: HIV- without major depressive disorder (MDD) [reference], HIV-with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20-10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45-1.95) compared with HIV-participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV- and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11-1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58-0.99).Conclusions-Our study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.