Cardiac risk factors in patients with diabetes mellitus and major depression
Cardiac risk factors in patients with diabetes mellitus and major depression
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DOI：
10.1111/j.1525-1497.2004.30405.x
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发表时间：
2004-12-01
影响因子：
5.7
通讯作者：
Young, B
中科院分区：
文献类型：
--
作者：
Katon, WJ;Lin, EHB;Young, B
目的：与医疗对照组相比，糖尿病患者的重度抑郁症患病率大约高出 2 倍。我们在有或没有心血管疾病 (CVD) 证据的糖尿病患者中探讨了重性抑郁与 8 种心脏危险因素之间的关联。设计：对 4,225 名糖尿病患者进行了邮寄调查问卷，以获得有关抑郁状态、糖尿病自我护理（饮食、运动和吸烟）、糖尿病史和人口统计的数据。在自动化数据的基础上，我们测量了糖尿病并发症、糖化血红蛋白、医疗合并症、低密度脂质水平、甘油三酯水平、高血压的诊断和微量白蛋白尿的证据。根据是否存在 CVD 对亚组进行单独分析。地点：非营利性健康维护组织的 9 个初级保健诊所。主要结果：患有重度抑郁症和糖尿病的患者出现 3 种或更多心血管危险因素的可能性是无抑郁症的糖尿病患者的 1.5 至 2 倍（无 CVD 患者为 62.5% vs 38.4%，有 CVD 患者为 61.3% vs 45%）。与无心脏病的非抑郁糖尿病患者相比，符合重度抑郁症标准的无心血管疾病的糖尿病患者更有可能吸烟、体重指数 (BMI) 大于或等于 30 kg/m(2)、久坐的生活方式以及 HbA(1c) 水平 >8.0%。与有心脏病证据的非抑郁糖尿病患者相比，患有重度抑郁症、糖尿病和心脏病证据的患者的 BMI 大于或等于 30 kg/m(2)、久坐的生活方式和甘油三酯水平 > 400 mg/dl 的可能性明显更高。结论：患有重度抑郁症和糖尿病（伴或不伴心脏病证据）的患者有更多的 CVD 危险因素。旨在减少这些危险因素的干预措施可能需要解决重度抑郁症的治疗才能有效。
OBJECTIVE: The prevalence of major depression is approximately 2-fold higher in patients with diabetes mellitus compared to medical controls. We explored the association of major depression with 8 cardiac risk factors in diabetic patients with and without evidence of cardiovascular disease (CVD).DESIGN: A mail survey questionnaire was administered to a population-based sample of 4,225 patients with diabetes to obtain data on depression status, diabetes self-care (diet, exercise, and smoking), diabetes history, and demographics. On the basis of automated data we measured diabetes complications, glycosylated hemoglobin, medical comorbidity, low-density lipid levels, triglyceride levels, diagnosis of hypertension, and evidence of microalbuminuria. Separate analyses were conducted for subgroups according to the presence or absence of CVD.SETTING: Nine primary care clinics of a nonprofit health maintenance organization.MAIN RESULTS: Patients with major depression and diabetes were 1.5- to 2-fold more likely to have 3 or more cardiovascular risk factors as patients with diabetes without depression (62.5% vs 38.4% in those without CVD, and 61.3% vs 45% in those with CVD). Patients with diabetes without CVD who met criteria for major depression were significantly more likely to be smokers, to have a body mass index (BMI) greater than or equal to 30 kg/m(2), to lead a more sedentary lifestyle, and to have HbA(1c) levels of >8.0% compared to nondepressed patients with diabetes without heart disease. Patients with major depression, diabetes, and evidence of heart disease were significantly more likely to have a BMI greater than or equal to 30 kg/m(2), a more sedentary lifestyle, and triglyceride levels > 400 mg/dl than nondepressed diabetic patients with evidence of heart disease.CONCLUSIONS: Patients with major depression and diabetes with or without evidence of heart disease have a higher number of CVD risk factors. Interventions aimed at decreasing these risk factors may need to address treatment for major depression in order to be effective.