Depressive Symptoms and Risk of Cardiovascular Events in Blacks: Findings From the Jackson Heart Study.
Depressive Symptoms and Risk of Cardiovascular Events in Blacks: Findings From the Jackson Heart Study.
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DOI：
10.1161/circoutcomes.115.001800
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发表时间：
2015-11
期刊：
影响因子：
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通讯作者：
Curtis LH
中科院分区：
文献类型：
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作者：
O'Brien EC;Greiner MA;Sims M;Hardy NC;Wang W;Shahar E;Hernandez AF;Curtis LH
大多数关于抑郁症和心血管风险的研究都是在白人人群中进行的。我们在一个以社区为基础的非裔美国人队列中调查了这种联系。我们使用杰克逊心脏研究的数据来调查2000至2004年间基线抑郁症状与10年来发生的中风和冠心病之间的关系。我们使用卡普兰-梅耶估计和考克斯比例风险模型来评估心血管事件风险，使用3个暴露变量：任何抑郁症状(CES-D评分≥16)；无(评分16)、轻度(评分16至小于21)和重度抑郁(评分≥21)；以及流行病学研究中心抑郁症评分每增加1个SD。模型根据中风或冠心病风险评分和行为风险因素进行了调整。在3309名没有中风病史的参与者中，738人(22.3%)有基线抑郁症状。无冠心病史的患者中有基线抑郁症状的比例相似(21.8%)。在有任何抑郁症状的参与者中，未调整的10年中风风险与没有抑郁症状的参与者相似(3.7%比2.6%；P=.12)。在有抑郁症状的参与者中，未调整的CHD发生率更高(5.6%比3.6%；p=0.03)，在调整了临床和行为风险因素后，差异持续存在，但在调整应对策略后，差异不存在。在比较主要抑郁症状和没有抑郁症状的调整模型中，有主要抑郁症状的患者中风的风险增加了一倍(HR，1.95；95%CI，1.02-3.71；P=0.04)。在连续模型中，CES-D评分每增加1SD，调整后的卒中风险增加30%(P=0.04)。在调整了临床和行为风险因素的模型中，也观察到了与CHD事件类似的相关性，但在调整应对策略后，相关性并不显著。在以社区为基础的非裔美国人队列中，在调整了临床和行为风险因素后，主要抑郁症状与中风和冠心病的风险更高相关。
Most studies of depression and cardiovascular risk have been conducted in white populations. We investigated this association in a community-based cohort of African Americans. We used data from the Jackson Heart Study to investigate associations of baseline depressive symptoms between 2000 and 2004 with incident stroke and coronary heart disease over 10 years. We used Kaplan-Meier estimates and Cox proportional hazards models to assess cardiovascular event risk using 3 exposure variables: any depressive symptoms (CES-D score ≥ 16); none (score < 16), minor (score 16 to less than 21) and major depression (score ≥ 21); and Center for Epidemiologic Studies Depression (CES-D) score per 1 SD increase. Models were adjusted for a stroke or CHD risk score and behavioral risk factors. Of 3309 participants with no stroke history, 738 (22.3%) had baseline depressive symptoms. A similar proportion with no prior coronary heart disease had baseline depressive symptoms (21.8%). The unadjusted 10-year risk of stroke was similar among participants with any compared with no depressive symptoms (3.7% vs 2.6%; P = .12). Unadjusted CHD rates were higher among participants with depressive symptoms (5.6 % vs. 3.6 %; p=.03), and differences persisted after adjustment for clinical and behavioral risk factors but not after adjustment for coping strategies. In adjusted models comparing major vs no depressive symptoms, patients with major depressive symptoms had a twofold greater hazard of stroke (HR, 1.95; 95% CI, 1.02–3.71; P = .04). In continuous models, a 1 SD increase in CES-D score was associated with a 30% increase in adjusted incident stroke risk (P = .04). Similar associations were observed for incident CHD in models adjusted for clinical and behavioral risk factors, but associations were not significant after adjustment for coping strategies. In a community-based cohort of African Americans, major depressive symptoms were associated with greater risks of incident stroke and coronary heart disease after adjustment for clinical and behavioral risk factors.