Aspirin decreases the risk of depression in older men with high plasma homocysteine.
Aspirin decreases the risk of depression in older men with high plasma homocysteine.
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DOI：
10.1038/tp.2012.79
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发表时间：
2012-08-14
影响因子：
6.8
通讯作者：
Hankey GJ
中科院分区：
文献类型：
--
作者：
Almeida OP;Flicker L;Yeap BB;Alfonso H;McCaul K;Hankey GJ
高血浆同型半胱氨酸（tHcy）与心血管事件和抑郁症的风险增加有关。摄入b族维生素（B6、B9和B12）可减少约15%的维生素c，但对这些健康结果的影响并不明确，这表明这种关系要么不是因果关系，要么被其他因素混淆了。最近的随机试验结果表明，抗血小板治疗可能混淆这些关联。该横断研究评估了3687名年龄为69-87岁的男性的临床显著抑郁症病史（老年抑郁症量表15项大于或小于7）或在西澳大利亚数据链接系统中记录的抑郁症诊断，并收集了关于阿司匹林、b族维生素和抗抑郁药物的使用的信息，以及由Charlson指数评估的年龄、教育、生活安排、吸烟史和医疗合并症。参与者捐献血液样本用于测量tHcy，并且浓度大于或等于15 μmol l−1被认为是高的。513名（13.9%）男性表现出抑郁迹象，其中31.4%的人tHcy高，41.5%的人服用阿司匹林，6.8%的人服用b族维生素。多因素logistic回归显示，高tHcy与抑郁几率增加相关(比值比（OR)=1.60, 95%可信区间(CI)= 1.20-2.14）， b族维生素的使用也是如此（OR=1.95, 95% CI= 1.21-3.13）。高tHcy与阿司匹林使用之间存在显著的相互作用（OR=0.57, 95% CI= 0.36-0.91），但高tHcy与b族维生素使用之间没有显著的相互作用（OR=0.80, 95% CI= 0.26-2.46）。这些分析根据吸烟状况、查尔森指数和抗抑郁药的使用情况进行了调整。本研究结果表明，使用阿司匹林的老年高thy男性患抑郁症的风险较低，并提示抗血小板治疗可能是一种有效的预防或管理策略。需要随机试验来证实阿司匹林对高tHcy人群的抗抑郁作用。
High total plasma homocysteine (tHcy) is associated with increased risk of cardiovascular events and depression. Consumption of B-vitamins (B6, B9 and B12) reduces tHcy by about 15%, but has equivocal effects on these health outcomes, suggesting that this relationship is either not causal or is confounded by other factors. The results of recent randomized trials suggest that antiplatelet therapy may confound these associations. This cross-sectional study assessed 3687 men aged 69–87 years for history of clinically significant depression (Geriatric Depression Scale 15 items ⩾7) or a recorded diagnosis of depression in the Western Australian Data Linkage System, and collected information on the use of aspirin, B-vitamins and antidepressant medication, along with age, education, living arrangements, smoking history and medical comorbidity as assessed by the Charlson index. Participants donated a blood sample for the measurement of tHcy, and concentrations⩾15 μmol l−1 were considered high. Five hundred and thirteen (13.9%) men showed evidence of depression, and of those 31.4% had high tHcy, 41.5% were using aspirin, 6.8% were consuming B-vitamins. Multivariate logistic regression showed that high tHcy was associated with increased odds of depression (odds ratio (OR)=1.60, 95% confidence interval (CI)=1.20–2.14), as was the use of B-vitamins (OR=1.95, 95% CI=1.21–3.13). There was a significant interaction between high tHcy and aspirin use (OR=0.57, 95% CI=0.36–0.91), but not between high tHcy and B-vitamin use (OR=0.80, 95% CI=0.26–2.46). The analyses were adjusted for smoking status, Charlson index and use of antidepressants. The results of this study indicate that older men with high tHcy who use aspirin have lower risk of depression, and suggest that antiplatelet therapy may be an effective preventive or management strategy for these cases. Randomized trials are required to confirm the antidepressant effect of aspirin in people with high tHcy.