Depression and coronary heart disease in women with diabetes
Depression and coronary heart disease in women with diabetes
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DOI：
10.1097/01.psy.0000041624.96580.1f
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发表时间：
2003-05-01
影响因子：
3.3
通讯作者：
Carney, RM
中科院分区：
文献类型：
--
作者：
Clouse, RE;Lustman, PJ;Carney, RM
目的：在非糖尿病患者中，女性对冠心病（CHD）的表现和病程的保护作用在糖尿病患者中减弱。在非糖尿病人群中，抑郁预示着冠心病的发病和预后不良。我们假设女性糖尿病患者中抑郁症的两倍率可以帮助解释女性糖尿病患者中冠心病的高患病率。方法：76例女性1型和2型糖尿病患者（N = 16）或未（N = 60）在指标评估中有活动性重度抑郁症（DSM-III），每年系统调查糖尿病及其并发症长达10年。使用生存分析统计检查冠心病和其他大血管并发症的发生率与抑郁状态的关系。结合其他冠心病危险因素（年龄、糖尿病病程、体重指数、糖化血红蛋白、高血压、高脂血症或吸烟）的多变量模型被用来确定抑郁对预后的独立影响。结果：抑郁组的冠心病发展明显更快（10年曲线间p < 0.01），在控制了体重指数的基线差异后，这种效应持续存在。在多变量模型中，抑郁仍然是冠心病的独立预测因子，年龄校正风险比为5.2 （95% CI: 1.4-18.9; p = 0.01）。相反，抑郁不能预测临床明显的外周或脑血管疾病的发展。结论：在该糖尿病女性样本中，重度抑郁是加速冠心病发展的独立危险因素。抑郁症的识别和管理可以改善该性别亚组的糖尿病预后。
Objective: The protective effects of female gender on the appearance and course of coronary heart disease (CHD) in nondiabetic subjects are diminished in the presence of diabetes. Depression predicts onset of and poor outcome from CHD in nondiabetic populations. We hypothesized that the doubled rates of depression in female diabetic patients could help explain the high prevalence of CHD in women with diabetes. Method: Seventy-six female type 1 and type 2 diabetic patients with (N = 16) or without (N = 60) active major depression (DSM-III) at index evaluation underwent systematic annual investigation of diabetes and its complications for up to 10 years. Occurrences of CHD and other macrovascular complications were examined in relation to depression status using survival analysis statistics. A multivariate model incorporating other CHD risk factors (age, duration of diabetes, body mass index, glycosylated hemoglobin, and presence of hypertension, hyperlipidemia, or tobacco use) was used to determine independent effects of depression on outcome. Results: Development of CHD was significantly more rapid in the depressed subset (p < 0.01 between 10-year curves), an effect that persisted after controlling for base-line differences in body mass index. Depression also was retained as an independent predictor of CHD in the multivariate model with an age-adjusted hazard ratio of 5.2 (95% CI: 1.4-18.9; p = .01). In contrast, depression did not predict the development of clinically apparent peripheral or cerebrovascular disease. Conclusions: In this sample of diabetic women, major depression was an independent risk factor that accelerated the development of CHD. Depression recognition and management may improve outcomes from diabetes in this gender subgroup.