Cardiovascular disease and subsequent risk of psychiatric disorders: a nationwide sibling-controlled study.
Cardiovascular disease and subsequent risk of psychiatric disorders: a nationwide sibling-controlled study.
复制标题
DOI：
10.7554/elife.80143
复制
发表时间：
2022-10-21
期刊：
影响因子：
7.7
通讯作者：
Valdimarsdóttir U
中科院分区：
文献类型：
--
作者：
Shen Q;Song H;Aspelund T;Yu J;Lu D;Jakobsdóttir J;Bergstedt J;Yi L;Sullivan P;Sjölander A;Ye W;Fall K;Fang F;Valdimarsdóttir U
心血管疾病（CVD）和选定的精神疾病之间的关联已被频繁地提出，而在这种关联的家族因素和合并症的潜在作用很少被调查。我们确定了1987年至2016年在瑞典新诊断为CVD的869，056例患者，无精神疾病史，这些患者的910，178名同胞以及10名年龄和性别匹配的独立无关人群对照（N = 8，690，560）。调整多种共病条件，我们使用灵活的参数模型和考克斯模型来估计CVD与所有后续精神疾病风险的相关性，比较CVD患者与未受影响的同胞和人群对照的首次精神疾病发病率。CVD患者诊断时的中位年龄为60岁，59.2%为男性。在长达30年的随访中，CVD患者及其同胞和人群对照的精神疾病粗发病率分别为7.1、4.6和4.0/1000人-年。在同胞比较中，我们观察到CVD诊断后第一年（风险比[HR]，2.74; 95%置信区间[CI]，2.62-2.87）和之后（1.45; 95% CI，1.42-1.48）精神疾病的风险增加。在所有类型的精神疾病和所有CVD诊断中观察到风险增加。我们在人群比较中观察到了类似的关联。诊断后第一年内发生共病精神障碍的CVD患者与无此类共病的患者相比，随后CVD死亡的风险升高（HR，1.55; 95%CI，1.44-1.67）。诊断为CVD的患者发生精神疾病的风险升高，与共有的家族因素和共病状况无关。CVD患者的共病精神疾病与心血管死亡风险较高相关，这表明精神共病的监测和治疗应被视为新诊断CVD患者临床管理的一个组成部分。这项工作得到了欧盟地平线2020研究和创新行动赠款的支持（CoMorMent，授予UV，PFS和FF的第847776号），卓越奖，冰岛研究基金（授予UV的第163362-051号），ERC整合者赠款（StressGene，UV的授权号726413）、瑞典研究理事会（PFS的授权号D 0886501）和US NIMH R 01 MH 123724（PFS）。
The association between cardiovascular disease (CVD) and selected psychiatric disorders has frequently been suggested while the potential role of familial factors and comorbidities in such association has rarely been investigated. We identified 869,056 patients newly diagnosed with CVD from 1987 to 2016 in Sweden with no history of psychiatric disorders, and 910,178 full siblings of these patients as well as 10 individually age- and sex-matched unrelated population controls (N = 8,690,560). Adjusting for multiple comorbid conditions, we used flexible parametric models and Cox models to estimate the association of CVD with risk of all subsequent psychiatric disorders, comparing rates of first incident psychiatric disorder among CVD patients with rates among unaffected full siblings and population controls. The median age at diagnosis was 60 years for patients with CVD and 59.2% were male. During up to 30 years of follow-up, the crude incidence rates of psychiatric disorder were 7.1, 4.6, and 4.0 per 1000 person-years for patients with CVD, their siblings and population controls. In the sibling comparison, we observed an increased risk of psychiatric disorder during the first year after CVD diagnosis (hazard ratio [HR], 2.74; 95% confidence interval [CI], 2.62–2.87) and thereafter (1.45; 95% CI, 1.42–1.48). Increased risks were observed for all types of psychiatric disorders and among all diagnoses of CVD. We observed similar associations in the population comparison. CVD patients who developed a comorbid psychiatric disorder during the first year after diagnosis were at elevated risk of subsequent CVD death compared to patients without such comorbidity (HR, 1.55; 95% CI, 1.44–1.67). Patients diagnosed with CVD are at an elevated risk for subsequent psychiatric disorders independent of shared familial factors and comorbid conditions. Comorbid psychiatric disorders in patients with CVD are associated with higher risk of cardiovascular mortality suggesting that surveillance and treatment of psychiatric comorbidities should be considered as an integral part of clinical management of newly diagnosed CVD patients. This work was supported by the EU Horizon 2020 Research and Innovation Action Grant (CoMorMent, grant no. 847776 to UV, PFS, and FF), Grant of Excellence, Icelandic Research Fund (grant no. 163362-051 to UV), ERC Consolidator Grant (StressGene, grant no. 726413 to UV), Swedish Research Council (grant no. D0886501 to PFS), and US NIMH R01 MH123724 (to PFS).