Depression and risk of heart failure among older persons with isolated systolic hypertension
Depression and risk of heart failure among older persons with isolated systolic hypertension
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DOI：
10.1001/archinte.161.14.1725
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发表时间：
2001-07-23
影响因子：
--
通讯作者：
Vaccarino, V
中科院分区：
文献类型：
--
作者：
Abramson, J;Berger, A;Vaccarino, V
背景资料：研究人员已经表明，抑郁症与冠心病的风险增加有关，特别是心肌梗死。然而，它是未知的抑郁症，独立的与心肌梗死，是一个危险因素heartfailure.Methods：本研究探讨抑郁症是否是一个预测事件心力衰竭4538人年龄在60岁及以上的单纯收缩期高血压谁参加了老年人的收缩期高血压计划（SHEP）。抑郁定义为基线时流行病学研究中心抑郁量表（CES-D）评分≥ 16分。采用考克斯比例风险回归分析抑郁与心力衰竭的关系。4317名非抑郁症患者中有138名（3.2%）发生心力衰竭，221名抑郁症患者中有18名（8.1%）发生心力衰竭。控制年龄后;性;种族;心肌梗死、糖尿病或心绞痛病史;血压;胆固醇水平;心电图异常;吸烟;残疾; SHEP治疗组，抑郁症患者发生心力衰竭的风险比非抑郁症患者高2倍以上（风险比，2.59; 95%可信区间，1.57-4.27; P <0.001）。在随访期间对心肌梗死的发生率进行额外调整后，抑郁症患者的心力衰竭风险仍然较高（危害比，2.82; 95%置信区间，1.71-4.67; P <0.001）。结论：抑郁症与老年单纯收缩期高血压患者心力衰竭风险的显著增加独立相关。这种关联似乎不是由心肌梗死介导的。
Background: Investigators have shown that depression is associated with an increased risk of coronary heart disease in general and myocardial infarction in particular. However, it is unknown whether depression, independent of its association with myocardial infarction, is a risk factor for heart failure.Methods: This study examined whether depression was a predictor of incident heart failure among 4538 persons aged 60 years and older with isolated systolic hypertension who were enrolled in the Systolic Hypertension in the Elderly Program (SHEP). Depression was defined as a score of 16 or more at baseline on the Center for Epidemiological Studies Depression Scale (CES-D). The relationship between depression and heart failure was assessed using Cox proportional hazards regression.Results: The average follow-up was 4.5 years. Heart failure developed in 138 (3.2%) of 4317 nondepressed persons and in 18 (8.1%) of 221 depressed persons. After controlling for age; sex; race; history of myocardial infarction, diabetes, or angina; blood pressure; cholesterol levels; electrocardiographic abnormalities; smoking; disability; and SHEP treatment group, depressed persons had more than a 2-fold higher risk of developing heart failure compared with nondepressed persons (hazard ratio, 2.59; 95% confidence interval, 1.57-4.27; P < .001). After additional adjustment for the occurrence of myocardial infarction during follow-up, depressed persons remained at elevated risk of heart failure (hazard ratio, 2.82; 95% confidence interval, 1.71-4.67; P < .001).Conclusions: Depression is independently associated with a substantial increase in the risk of heart failure among older persons with isolated systolic hypertension. This association does not appear to be mediated by myocardial infarction.