Depression, inflammation and incident cardiovascular disease in women with suspected coronary ischemia - The national heart, lung, and blood institute-sponsored WISE study
Depression, inflammation and incident cardiovascular disease in women with suspected coronary ischemia - The national heart, lung, and blood institute-sponsored WISE study
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DOI：
10.1016/j.jacc.2007.07.069
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发表时间：
2007-11-20
影响因子：
24
通讯作者：
Metz, C. Noel Bairey
中科院分区：
文献类型：
--
作者：
Vaccarino, Viola;Johnson, B. Delia;Metz, C. Noel Bairey
本研究的目的是前瞻性地研究炎症是否可以解释抑郁症和心血管疾病之间的关系。背景目前尚不清楚炎症是否是抑郁症和心血管疾病之间的联系。方法我们检测了559名完成Beck抑郁量表（BDI）的疑似冠状动脉缺血妇女的C反应蛋白（CRP）和白细胞介素（IL）-6。并随访了5.9年。我们考虑了过去和现在的抑郁症指标，将女性分为3组：1）抑郁症，既有抑郁症状升高（BDI >= 10），又有需要治疗的抑郁症的既往诊断; 2）可能的抑郁症，有任何一个指标，但不是两个指标; 3）没有抑郁症，没有抑郁症的指标。主要结局是心血管事件的发生率（非致命性心肌梗死、中风、充血性心力衰竭和心血管疾病相关死亡率的住院时间）。结果与无抑郁症的女性相比，抑郁症女性的CRP高70%（p = 0.0008）和IL-6高25%（p = 0.04），而可能患有抑郁症的女性CRP高30%（p = 0.02）和IL-6高28%（p = 0.01）。抑郁是CVD的重要预测因子（风险比2.58，p = 0.0009），但可能的抑郁不是（风险比1.12，p = 0.68）。其他患者因素的调整对结果没有实质性影响。添加CRP使抑郁的估计值降低13%，添加IL-6使其降低4%。抑郁症和炎症生物标志物仍然是独立的预测outcome.Conclusions尽管他们强大的抑郁症，炎症生物标志物解释只有一小部分抑郁症和CVD发病率之间的关联。
Objectives The purpose of this study was to examine prospectively whether inflammation explains the relationship between depression and cardiovascular disease (CVD).Background It is unclear whether inflammation is a mechanism linking depression to CVD.Methods We measured C-reactive protein (CRP) and interleukin (IL)-6 in 559 women with suspected coronary ischemia who completed the Beck Depression Inventory (BDI) at baseline and were followed over 5.9 years. We considered indicators of past and current depression to classify women into 3 groups: 1) depression, having both elevated depressive symptoms (BDI >= 10) and a previous diagnosis of depression requiring treatment; 2) possible depression, having either indicator but not both; and 3) no depression, having neither indicator of depression. The main outcome was incidence of CVD events (hospital stays for nonfatal myocardial infarction, stroke, congestive heart failure, and CVD-related mortality).Results Compared with women without depression, women with depression had a 70% higher CRP (p = 0.0008) and a 25% higher IL-6 (p = 0.04), whereas women with possible depression had 30% higher CRP (p = 0.02) and 28% higher IL-6 (p = 0.01). Depression was a significant predictor of CVD (hazard ratio 2.58, p = 0.0009), but possible depression was not (hazard ratio 1.12, p = 0.68). Adjustment for other patient factors did not substantially affect the results. Addition of CRP decreased the estimate for depression by 13% and addition of IL-6 decreased it by 4%. Both depression and inflammatory biomarkers remained independent predictors of outcome.Conclusions Despite their robust association with depression, inflammatory biomarkers explain only a small portion of the association between depression and CVD incidence.