Ariyo A A, Haan M, Tangen C M, Rutledge J C, Cushman M, Dobs A, Furberg C D
Division of Cardiovascular Medicine, Johns Hopkins University, Baltimore, MD, USA.
Circulation. 2000 Oct 10;102(15):1773-9. doi: 10.1161/01.cir.102.15.1773.
Several epidemiological studies have associated depressive symptoms with cardiovascular disease. We investigated whether depressive symptoms constituted a risk for coronary heart disease (CHD) and total mortality among an apparently healthy elderly cohort.
In a prospective cohort of 5888 elderly Americans (>/=65 years) who were enrolled in the Cardiovascular Health Study, 4493 participants who were free of cardiovascular disease at baseline provided annual information on their depressive status, which was assessed using the Depression Scale of the Center for Epidemiological Studies. These 4493 subjects were followed for 6 years for the development of CHD and mortality. The cumulative mean depression score was assessed for each participant up to the time of event (maximum 6-year follow-up). Using time-dependent, proportional-hazards models, the unadjusted hazard ratio associated with every 5-unit increase in mean depression score for the development of CHD was 1.15 (P:=0.006); the ratio for all-cause mortality was 1.29 (P:<0.0001). In multivariate analyses adjusted for age, race, sex, education, diabetes, hypertension, cigarette smoking, total cholesterol, triglyceride level, congestive heart failure, and physical inactivity, the hazard ratio for CHD was 1.15 (P:=0.006) and that for all-cause mortality was 1.16 (P:=0.006). Among participants with the highest cumulative mean depression scores, the risk of CHD increased by 40% and risk of death by 60% compared with those who had the lowest mean scores.
Among elderly Americans, depressive symptoms constitute an independent risk factor for the development of CHD and total mortality.
多项流行病学研究已将抑郁症状与心血管疾病联系起来。我们调查了在一个看似健康的老年队列中，抑郁症状是否构成冠心病（CHD）和全因死亡的风险因素。
在心血管健康研究中纳入的5888名年龄≥65岁的美国老年人前瞻性队列中，4493名基线时无心血管疾病的参与者每年提供其抑郁状态信息，使用流行病学研究中心抑郁量表进行评估。对这4493名受试者进行了6年的随访，以观察冠心病的发生和死亡情况。在事件发生时（最长6年随访）为每位参与者评估累积平均抑郁评分。使用时间依赖的比例风险模型，平均抑郁评分每增加5个单位，冠心病发生的未调整风险比为1.15（P = 0.006）；全因死亡的风险比为1.29（P < 0.0001）。在对年龄、种族、性别、教育程度、糖尿病、高血压、吸烟、总胆固醇、甘油三酯水平、充血性心力衰竭和身体活动不足进行调整的多变量分析中，冠心病的风险比为1.15（P = 0.006），全因死亡的风险比为1.16（P = 0.006）。在累积平均抑郁评分最高的参与者中，与平均评分最低的参与者相比，冠心病风险增加了40%，死亡风险增加了60%。
在美国老年人中，抑郁症状是冠心病发生和全因死亡的独立风险因素。
