Depression as a Driving Force for Low Time in Therapeutic Range and Dementia in Patients With and Without Atrial Fibrillation.
Depression as a Driving Force for Low Time in Therapeutic Range and Dementia in Patients With and Without Atrial Fibrillation.
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抑郁症是房颤患者治疗范围缩短和痴呆的驱动力。
DOI：
10.1016/j.amjcard.2021.05.021
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Bunch,TJared
中科院分区：
文献类型：
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作者：
Rizzi,ScottA;Knight,Stacey;May,HeidiT;Woller,ScottC;Stevens,ScottM;Steinberg,BenjaminA;Bair,TamiL;Anderson,JeffreyL;Muhlestein,JosephB;Knowlton,KirkU;Bunch,TJared
抗凝治疗范围内的时间(TTR)和抑郁都与痴呆风险有关。本研究的目的是检验抑郁对TTR的影响，并描述抑郁和TTR对长期痴呆风险的分割贡献。我们研究了2003至2015年间14,953名接受华法林(靶INR2-3)抗凝的房颤(AF)、静脉血栓栓塞症(VTE)或机械心脏瓣膜患者。我们排除了华法林治疗前或治疗后6个月内确诊为痴呆症的患者。我们使用有限混合模型和Logistic回归检验了抑郁症与TTR的关联，并使用多变量Cox风险回归来确定TTR和抑郁与3年和13年后痴呆事件的关联。40%(n=46055)的患者在服用华法林之前或期间被诊断为抑郁症。抑郁症患者的ttr显著低于非抑郁症患者，并且ttr<；50%的可能性是非抑郁症患者的1.37倍(p<；0.0001)。在随访期间，4.2%的患者在3年内被诊断为痴呆症，而在所有时间的随访中，这一比例为12%。无论抑郁状态如何，≤50%TTR值的患者患痴呆症的3年风险最高。3年患痴呆症的风险与ttr(p<；0.0001)有关，但与抑郁症无关。然而，对于所有时间的痴呆症，ttr(p<；0.0001)和抑郁症(p<；0.0001)及其相互作用(p=0.049)都与痴呆症有关。对于TTR值最低的患者，抑郁使长期痴呆的风险增加1.69倍(95%可信区间：1.33，2.15)。抑郁症在接受华法林治疗的患者中普遍存在，并与TTR值的显著降低有关。总而言之，在服用华法林的患者中，TTR降低似乎增加了3年痴呆的风险，并且TTR降低和抑郁相互作用增加了全天候痴呆的风险。
Both time in therapeutic range (TTR) for anticoagulation and depression are associated with dementia risk. The purposes of this study were to examine the impact of depression on TTR and to describe the partitioned contribution of depression and TTR on long-term dementia risk.We studied 14,953 patients anticoagulated with warfarin (target INR 2-3) for atrial fibrillation (AF), venous thromboembolism (VTE), or a mechanical heart valve from 2003 to 2015. We excluded patients with a diagnosis of dementia before or within 6 months of warfarin initiation. We examined the association of depression with TTR using finite mixture modeling and logistic regression and utilized multivariable Cox hazard regression to determine the association of TTR and depression with incident dementia at 3 and 13 years. Forty % (n = 6055) of patients were diagnosed with depression before or while on warfarin. Patients with depression had significantly lower TTR and were 1.37 times more likely to have TTR <50% than non-depressed patients (p <0.0001). During follow-up, 4.2% of patients received the diagnosis of dementia within 3 years as compared to 12% during all-time follow up. The 3-year risk of dementia was highest for patients with a ≤50% TTR regardless of depression status. The 3-year dementia risk was associated with TTR (p <0.0001) but not depression. However, for all-time dementia both TTR (p <0.0001) and depression (p <0.0001) as well as their interaction (p = 0.049) were associated with dementia. Depression increased the risk of long-term dementia by 1.69 fold (95% CI: 1.33, 2.15) for patients with the lowest TTR. Depression is prevalent in patients managed with warfarin and is associated with significant decreases in TTR. In conclusion, decreased TTR appears to increase 3-year dementia risk and both low TTR and depression interact to increase risk for all-time dementia in patients taking warfarin.