Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study.
Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study.
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冠状动脉疾病患者的抑郁症状的运动和药理治疗：乐观的结果（了解运动和抗抑郁治疗的预后益处）研究。
DOI：
10.1016/j.jacc.2012.04.040
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发表时间：
2012-09-18
影响因子：
24
通讯作者：
Hinderliter, Alan L.
中科院分区：
文献类型：
--
作者：
Blumenthal, James A.;Sherwood, Andrew;Babyak, Michael A.;Watkins, Lana L.;Smith, Patrick J.;Hoffman, Benson M.;O'Hayer, C. Virginia F.;Mabe, Stephanie;Johnson, Julie;Doraiswamy, P. Murali;Jiang, Wei;Schocken, Douglas D.;Hinderliter, Alan L.
目的：评价运动和抗抑郁药物治疗对改善冠心病抑郁患者抑郁症状和改善心血管生物标志物的疗效。虽然有很好的证据表明临床抑郁症与预后不良有关，但目前最佳的治疗策略还没有很好的定义。101例有抑郁症状的冠心病患者接受了抑郁评估，包括精神病学访谈和汉密尔顿抑郁量表(HAM-D)。参与者被随机分配到4个月的有氧运动(每周3次)、舍曲林(50-200 mg/天)或安慰剂。心血管生物标志物的其他评估包括心率变异性(HRV)、内皮功能、压力反射敏感性、炎症和血小板功能的测量。16周后，所有组的HAM-D评分均有改善。有氧运动(M=−7.5[95%CI=−9.8，−5.0])和舍曲林(M=−6.1[95%CI=−8.4，−3.9])的参与者与安慰剂(M=−4.5[95%CI=−7.6，−1.5]；p=.034)相比，抑郁症状的减少幅度更大；运动和舍曲林在减少抑郁症状方面同样有效(p=.607)。与安慰剂相比，运动和药物往往使心率变异性得到更大的改善(p=.052)；与舍曲林相比，运动往往使心率变异性得到更大的改善(p=.093)。与安慰剂相比，运动和舍曲林使冠心病患者的抑郁症状得到更大的缓解。有证据表明，积极的治疗也可能改善心血管生物标志物，这表明它们可能对临床结果和生活质量有有益的影响。
To assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease (CHD). Although there is good evidence that clinical depression is associated with poor prognosis, optimal therapeutic strategies are currently not well-defined. 101 outpatients with CHD and elevated depressive symptoms underwent assessment of depression including a psychiatric interview and the Hamilton Rating Scale for Depression (HAM-D). Participants were randomized to 4 months of aerobic exercise (3 times/week), sertraline (50-200 mg/day), or placebo. Additional assessments of cardiovascular biomarkers included measures of heart rate variability (HRV), endothelial function, baroreflex sensitivity, inflammation, and platelet function. After 16 weeks, all groups showed improvement on HAM-D scores. Participants in both aerobic exercise (M= −7.5 [95% CI = −9.8, −5.0]) and sertraline (M= −6.1 [95% CI = −8.4, −3.9] achieved larger reductions in depressive symptoms compared to placebo (M= −4.5 [95% CI = −7.6, −1.5]; p = .034); exercise and sertraline were equally effective in reducing depressive symptoms (p = .607). Exercise and medication tended to result in greater improvements in HRV compared to placebo (p = .052); exercise tended to result in greater improvements in HRV compared to sertraline (p =.093) Both exercise and sertraline resulted in greater reductions in depressive symptoms compared to placebo in CHD patients. Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as quality of life.
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影响因子：
120.7
作者：
Blumenthal, JA;Sherwood, A;Hinderliter, A
通讯作者：
Hinderliter, A
影响因子：
2.8
作者：
Kop, WJ;Gottdiener, JS;Tracy, RP
通讯作者：
Tracy, RP
影响因子：
5.5
作者：
Dunn, AL;Trivedi, MH;Chambliss, HO
通讯作者：
Chambliss, HO
影响因子：
37.8
作者：
DeMets, DL;Califf, RM
通讯作者：
Califf, RM
影响因子：
1.8
作者：
CONOVER, WJ;IMAN, RL
通讯作者：
IMAN, RL