Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease.
Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease.
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DOI：
10.1001/jama.2008.711
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发表时间：
2008-11-26
影响因子：
120.7
通讯作者：
Browner, Warren S.
中科院分区：
文献类型：
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作者：
Whooley, Mary A.;de Jonge, Peter;Vittinghoff, Eric;Otte, Christian;Moos, Rudolf;Carney, Robert M.;Ali, Sadia;Dowray, Sunaina;Na, Beeya;Feldman, Mitchell D.;Schiller, Nelson B.;Browner, Warren S.
抑郁症状可预测冠心病患者的不良心血管结局，但造成这种关联的机制尚不清楚。确定为什么抑郁症状与心血管事件风险增加相关。 Heart and Soul 研究是一项前瞻性队列研究，对 1017 名稳定型冠心病门诊患者进行了平均 (SD) 4.8 (1.4) 年的随访。参与者于2000年9月11日至2002年12月20日期间从旧金山湾区的12个门诊诊所招募，并随访至2008年1月12日。使用患者健康问卷（PHQ）评估基线抑郁症状。我们使用比例风险模型来评估抑郁症状与随后的心血管事件（心力衰竭、心肌梗塞、中风、短暂性脑缺血发作或死亡）之间的关联在多大程度上可以通过基线疾病严重程度和潜在的生物或行为介质来解释。在 4876 人年的随访中，总共发生了 341 起心血管事件。 199 名有抑郁症状的参与者（PHQ 评分≥10）中，年龄调整后的心血管事件年发生率为 10.0%，818 名无抑郁症状的参与者中，心血管事件的年发生率为 6.7%（风险比 [HR]，1.50；95% 置信区间，[CI]，1.16–1.95；P=.002）。调整合并症和疾病严重程度后，抑郁症状与心血管事件发生率升高 31% 相关（HR，1.31；95% CI，1.00–1.71；P=.04）。对潜在生物介质的额外调整减弱了这种关联（HR，1.24；95% CI，0.94–1.63；P=.12）。对潜在的行为中介因素（包括缺乏身体活动）进行进一步调整后，没有显着关联（HR，1.05；95% CI，0.79–1.40；P=.75）。在这个冠心病门诊患者样本中，抑郁症状与不良心血管事件之间的关联很大程度上是由行为因素（尤其是缺乏身体活动）来解释的。
Depressive symptoms predict adverse cardiovascular outcomes in patients with coronary heart disease, but the mechanisms responsible for this association are unknown. To determine why depressive symptoms are associated with an increased risk of cardiovascular events. The Heart and Soul Study is a prospective cohort study of 1017 outpatients with stable coronary heart disease followed up for a mean (SD) of 4.8 (1.4) years. Participants were recruited between September 11, 2000, and December 20, 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up to January 12, 2008. Baseline depressive symptoms were assessed using the Patient Health Questionnaire (PHQ). We used proportional hazards models to evaluate the extent to which the association of depressive symptoms with subsequent cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack, or death) was explained by baseline disease severity and potential biological or behavioral mediators. A total of 341 cardiovascular events occurred during 4876 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 10.0% among the 199 participants with depressive symptoms (PHQ score ≥10) and 6.7% among the 818 participants without depressive symptoms (hazard ratio [HR], 1.50; 95% confidence interval, [CI], 1.16–1.95; P=.002). After adjustment for comorbid conditions and disease severity, depressive symptoms were associated with a 31% higher rate of cardiovascular events (HR, 1.31; 95% CI, 1.00–1.71; P=.04). Additional adjustment for potential biological mediators attenuated this association (HR, 1.24; 95% CI, 0.94–1.63; P=.12). After further adjustment for potential behavioral mediators, including physical inactivity, there was no significant association (HR, 1.05; 95% CI, 0.79–1.40; P=.75). In this sample of outpatients with coronary heart disease, the association between depressive symptoms and adverse cardiovascular events was largely explained by behavioral factors, particularly physical inactivity.
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