Post-Myocardial Infarction Anxiety or Depressive Symptoms and Risk of New Cardiovascular Events or Death: A Population-Based Longitudinal Study
Post-Myocardial Infarction Anxiety or Depressive Symptoms and Risk of New Cardiovascular Events or Death: A Population-Based Longitudinal Study
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DOI：
10.1097/psy.0000000000000115
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发表时间：
2014-11-01
影响因子：
3.3
通讯作者：
Vestergaard, Mogens
中科院分区：
文献类型：
--
作者：
Larsen, Karen Kjaer;Christensen, Bo;Vestergaard, Mogens
目的：研究心肌梗死（MI）后3个月焦虑症状和/或新发心血管事件与死亡之间的相关性，考虑已确定的风险因素，并将结果与抑郁症状的影响进行比较。MI后焦虑症状与新发心血管事件或死亡的复合结局相关，但既往研究未完全校正潜在混杂因素。目前尚不清楚焦虑症状是否与新发心血管事件和死亡独立相关。研究方法：一项基于人群的队列研究，对2009年1月1日至2009年12月31日期间首次MI的896例患者（70%符合条件）进行了随访，完成了医院焦虑和抑郁量表，随访至2012年7月31日。结果：在1975人-年的随访中，共发生239例新发心血管事件和94例死亡。考克斯比例风险模型显示，焦虑症状与新发心血管事件和死亡相关，仅对年龄进行了调整。当调整呼吸困难评分、体力活动和抑郁症状时，估计值降低，焦虑症状不再与新发心血管事件（风险比[HR] = 1.02，95%置信区间[CI] = 0.98-1.07）或死亡（HR = 0.94，95% CI = 0.88-1.01）相关。在完全校正的模型中，抑郁症状仍与死亡相关（HR = 1.13，95% CI = 1.05-1.21），但与新发心血管事件无关（HR = 1.02，95% CI = 0.99-1.06）。结论：心肌梗死后焦虑症状不是新发心血管事件或死亡的独立预后风险因素，而抑郁症状与死亡风险增加相关。
Objective: To examine the association between anxiety symptoms 3 months after myocardial infarction (MI) and/or new cardiovascular events and death, taking into account established risk factors, and to compare the results with those of the impact of depressive symptoms. Post-MI anxiety symptoms have been associated with a composite outcome of new cardiovascular events or death, but previous studies have not fully adjusted for potential confounders. It remains unclear whether anxiety symptoms are independently associated with both new cardiovascular events and death. Methods: A population-based cohort study of 896 persons (70% of eligible) with first-time MI between 1 January 2009 and 31 December 2009, completing the Hospital Anxiety and Depression Scale, were followed up until 31 July 2012. Results: A total of 239 new cardiovascular events and 94 deaths occurred during 1975 person-years of follow-up. Cox proportional hazards models showed that anxiety symptoms were associated with both new cardiovascular events and death in analysis adjusted for age only. The estimates decreased when adjusted for dyspnea score, physical activity, and depressive symptoms, and anxiety symptoms were no longer associated with new cardiovascular events (hazard ratio [HR] = 1.02, 95% confidence interval [CI] = 0.98-1.07) or with death (HR = 0.94, 95% CI = 0.88-1.01). In fully adjusted models, depressive symptoms remained associated with death (HR = 1.13, 95% CI = 1.05-1.21), but not with new cardiovascular events (HR = 1.02, 95% CI = 0.99-1.06). Conclusions: Post-MI anxiety symptoms were not an independent prognostic risk factor for new cardiovascular events or for death, whereas depressive symptoms were associated with an increased risk of mortality.