Depression, psychotropic medication, and risk of myocardial infarction - Prospective data from the Baltimore ECA follow-up
Depression, psychotropic medication, and risk of myocardial infarction - Prospective data from the Baltimore ECA follow-up
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DOI：
10.1161/01.cir.94.12.3123
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发表时间：
1996-12-15
期刊：
影响因子：
37.8
通讯作者：
Eaten, WW
中科院分区：
文献类型：
--
作者：
Pratt, LA;Ford, DE;Eaten, WW
背景有证据表明抑郁症增加心肌梗死（MR）的风险，但没有前瞻性研究表明抑郁症的测量符合临床标准。这项研究前瞻性地检查了重度抑郁发作是否会增加心肌梗死事件的风险，并评估了精神药物使用在这种关系中的作用。方法和结果该研究基于对流行病学流域地区研究（一项针对普通人群精神疾病的调查）的巴尔的摩队列的随访。1981年评估了重度抑郁发作、烦躁不安（2周悲伤）和精神药物使用史，1994年评估了自我报告的MI。1981年，在1551名无心脏病的受访者中，有64名MI。与无烦躁不安病史的受访者相比，与烦躁不安病史相关的MI的比值比为2.07（95%CI，1.16至3.71），与重度抑郁发作病史相关的比值比为4.54（95%CI，1.65至12.44），与冠状动脉危险因素无关。在多变量模型中，使用巴比妥类药物、甲丙氨酯、吩噻嗪类药物和锂与MI风险增加相关，而使用三环类抗抑郁药和苯二氮卓类药物与此无关。在没有烦躁不安的历史的个人，只有锂的使用与MI。结论这些数据表明，烦躁不安的历史和严重抑郁发作增加MI的风险。精神药物的使用和心肌梗死之间的关联可能是抑郁症和心肌梗死之间的主要关系的反映。
Background There is suggestive evidence that depression increases risk of myocardial infarction (Mr), but there are no prospective studies in which the measure of depression corresponds to clinical criteria. This study examines prospectively whether a major depressive episode increases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship.Methods and Results The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catchment Area Study, a survey of psychiatric disorders in the general population. A history of major depressive episode, dysphoria (2 weeks of sadness), and psychotropic medication use were assessed in 1981, and self-reported MI was assessed in 1994. Sixty-four MIs were reported among 1551 respondents free of heart trouble in 1981. Compared with respondents with no history of dysphoria, the odds ratio for MI associated with a history of dysphoria was 2.07 (95% CI, 1.16 to 3.71), and the odds ratio associated with a history of major depressive episode was 4.54 (95% CI, 1.65 to 12.44), independent of coronary risk factors. In multivariate models, use of barbiturates, meprobamates, phenothiazines, and lithium was associated with an increased risk of MI, whereas use of tricyclic antidepressants and benzodiazepines was not. Among individuals with no history of dysphoria, only lithium use was significantly associated with MI.Conclusions These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI. The association between psychotropic medication use and MI is probably a reflection of the primary relationship between depression and MI.