Depression and cardiovascular sequelae in postmenopausal women - The Women's Health Initiative (WHI)
Depression and cardiovascular sequelae in postmenopausal women - The Women's Health Initiative (WHI)
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DOI：
10.1001/archinte.164.3.289
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发表时间：
2004-02-09
影响因子：
--
通讯作者：
Dunbar-Jacob, J
中科院分区：
文献类型：
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作者：
Wassertheil-Smoller, S;Shumaker, S;Dunbar-Jacob, J
背景：亚临床抑郁症通常在临床上未被识别，可能会增加心血管疾病的风险。很少有研究前瞻性地调查老年女性与抑郁症相关的心血管事件。我们描述了一般健康的绝经后女性中抑郁症状的患病率、心血管相关性以及与随后的心血管事件的关系。方法：女性健康倡议观察性研究对 93676 名女性进行了平均 4.1 年的随访。使用流行病学研究中心抑郁量表的简短形式来测量基线抑郁症。心血管疾病 (CVD) 事件的风险是通过 Cox 比例风险模型根据多个人口统计、临床和危险因素协变量进行调整来估计的。结果：15.8% 的女性报告当前抑郁症状高于筛查截止点。抑郁症与 CVD 风险和合并症显着相关（比值比范围从高血压的 1.12 到中风或心绞痛病史的 1.60）。在没有 CVD 病史的女性中，在调整年龄、种族、教育、收入、糖尿病、高血压、吸烟、需要药物治疗的高胆固醇水平、体重指数和体力活动后，抑郁症是 CVD 死亡（相对风险，1.50）和全因死亡率（相对风险，1.32）的独立预测因素。服用抗抑郁药物并不会改变与抑郁症相关的风险。结论：很大一部分老年女性报告抑郁症状水平与 CVD 死亡和全因死亡率风险增加显着相关，即使在控制了既定的 CVD 危险因素后也是如此。早期识别和治疗亚临床抑郁症是否会降低心血管疾病风险仍有待临床试验确定。
Background: Subclinical depression, often clinically unrecognized, may pose increased risk of cardiovascular disease. Few studies have prospectively investigated cardiovascular events related to depression in older women. We describe prevalence, cardiovascular correlates, and relationship to subsequent cardiovascular events of depressive symptoms among generally healthy postmenopausal women.Methods: The Women's Health Initiative Observational Study followed up 93676 women for an average of 4.1 years. Depression was measured at baseline with a short form of the Center for Epidemiological Studies Depression Scale. Risks of cardiovascular disease (CVD) events were estimated from Cox proportional hazards models adjusting for multiple demographic, clinical, and risk factor covariates.Results: Current depressive symptoms above the screening cutoff point were reported by 15.8% of women. Depression was significantly related to CVD risk and comorbidity (odds ratios ranging from 1.12 for hypertension to 1.60 for history of stroke or angina). Among women with no history of CVD, depression was an independent predictor of CVD death (relative risk, 1.50) and all-cause mortality (relative risk, 1.32) after adjustment for age, race, education, income, diabetes, hypertension, smoking, high cholesterol level requiring medication, body mass index, and physical activity. Taking antidepressant medications did not alter the depression-associated risks associated.Conclusions: A large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD death and all-cause mortality, even after controlling for established CVD risk factors. Whether early recognition and treatment of subclinical depression will lower CVD risk remains to be determined in clinical trials.