Is there an association between depression and cardiovascular mortality or sudden death?
Is there an association between depression and cardiovascular mortality or sudden death?
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DOI：
10.2459/jcm.0b013e3282785240
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发表时间：
2008-04-01
影响因子：
3
通讯作者：
Pedaci, Mario
中科院分区：
文献类型：
--
作者：
Alboni, Paolo;Favaron, Elisa;Pedaci, Mario
许多研究和最近的荟萃分析的结果强烈表明，无论是在普通人群还是已知心脏病患者中，抑郁症都是导致总死亡率和心血管死亡率的一个危险因素。相比之下，抑郁症与猝死或心脏骤停之间的关系很少受到关注。这一问题在最近的三项研究中得到了调查；两项研究在普通人群中进行，结果显示抑郁症是猝死的独立危险因素。另一项研究是在急性心肌梗死（AMI）患者中进行的；抑郁症患者猝死的校正相对危险度（IRR）显著增加，但校正呼吸困难/疲劳（心脏病和抑郁症的常见症状）后，RR不再有统计学意义。然而，当认知情感性抑郁症状与躯体症状（呼吸困难/疲劳等）分开检查时，认知情感性抑郁症状与猝死之间有明显的关联趋势。因为风险因素只有在变量被二分类的多变量分析中才能被定义为“独立的”，所以心脏病和抑郁症之间存在共同症状是一个非常困难的问题。然而，综合起来，在普通人群和AMI患者中进行的研究结果强烈表明，抑郁症是猝死的一个重要危险因素。
The results of many studies and recent meta-analyses strongly suggest that depression is a risk factor for total and cardiovascular mortality, both in the general population and in patients with known heart disease. By contrast, the association between depression and sudden death or cardiac arrest has received little attention. This issue has been investigated in three recent studies; two were carried out in the general population and showed depression to be a independent risk factor for sudden death. The other study was carried out in patients with acute myocardial infarction (AMI); the adjusted relative risk (IRR) of sudden death was significantly increased in depressed patients but, after adjustment for dyspnea/fatigue (a common symptom for heart disease and depression), the RR was no longer statistically significant. However, when the cognitive-affective depressive symptoms were examined separately from the somatic ones (dyspnea/fatigue, etc.), there was a clear trend for an association between cognitive-affective symptoms and sudden death. Because a risk factor can be defined as 'independent' only in a multivariate analysis in which variables are dichotomized, the presence of common symptoms between heart disease and depression represents a very difficult problem. However, taken together, the results of studies carried out in the general population and in patients with AMI strongly suggest that depression is a significant risk factor for sudden death.