Symptoms of anxiety and depression in patients with stable coronary heart disease:: prognostic value and consideration of pathogenetic links
Symptoms of anxiety and depression in patients with stable coronary heart disease:: prognostic value and consideration of pathogenetic links
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DOI：
10.1097/hjr.0b013e3280142a02
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发表时间：
2007-08-01
影响因子：
--
通讯作者：
Brenner, Hermann
中科院分区：
文献类型：
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作者：
Rothenbacher, Dietrich;Hahmann, Harry;Brenner, Hermann
背景：我们评估了冠心病患者焦虑和抑郁症状与致命性和非致命性心血管疾病事件的关系，并考虑了几个潜在的致病联系。设计：这是一项前瞻性队列研究。方法本研究包括接受住院康复治疗的冠心病患者，采用医院焦虑和抑郁量表(HADS)评估焦虑和抑郁症状。结果在1052例冠心病患者中，16.1%有明显的焦虑症状评分，11.8%有明显的抑郁症状评分，5.9%有明显的抑郁症状评分。在3年的随访中，73例(6.9%)患者观察到致命性和非致命性心血管疾病事件。调整协变量后，与其他患者相比，有明显焦虑症状的患者发生心血管疾病事件的危险比(HR)为2.32[95%可信区间(CI)1.14-4.74]，而有抑郁症状的患者的HR为1.47(95%可信区间(CI)0.62-3.51)。在同时考虑焦虑和抑郁症状评分的模型中，与焦虑症状相关的心血管疾病事件的风险比增加到3.31(95%可信区间1.32-8.27)，而与抑郁症状关联的风险比降低(HR 0.62；95%可信区间0.20-1.87)。焦虑评分的增加与体重指数和收缩压呈正相关。结论焦虑症状对冠心病患者的长期预后有重要作用。它进一步表明，几种致病联系可能部分解释了风险的增加。
Background We evaluated the association of symptoms of anxiety and depression with fatal and non-fatal cardiovascular disease events among patients with coronary heart disease and considered several potential underlying pathogenetic links.Design This was a prospective cohort study.Methods In this study, including coronary heart disease patients undergoing an in-patient rehabilitation program, symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal cardiovascular disease events were determined during a 3-year follow-up.Results Of the 1052 patients with CHD 16.1% showed a borderline and 8.3% a manifest anxiety symptoms score, whereas 11.8 and 5.9% showed a borderline and manifest depressive symptoms score, respectively. During the 3-year follow-up fatal and non-fatal cardiovascular disease events were observed in 73 (6.9%) patients. After adjustment for covariates, patients having manifest anxiety symptoms had a statistically significant hazard ratio (HR) of 2.32 [95% confidence interval (CI) 1.14-4.74] for a cardiovascular disease event, and patients with depressive symptoms had an HR of 1.47 (95% Cl 0.62-3.51) compared to other patients. In a model considering anxiety and depressive symptom scores simultaneously, the hazard ratio for a cardiovascular disease event associated with anxiety symptoms increased to 3.31 (95% Cl 1.32-8.27), whereas the hazard ratio associated with depressive symptoms decreased (HR 0.62; 95% Cl 0.20-1.87). We found a positive association of increased anxiety scores with body mass index and systolic blood pressure.Conclusions The study suggests an important role especially for symptoms of anxiety for long-term prognosis of patients with known coronary heart disease. It furthermore suggests that several pathogenetic links may partly explain the increased risk.