Carney Robert M, Freedland Kenneth E, Miller Gregory E, Jaffe Allan S
Department of Psychiatry, Suite 420, Behavioral Medicine Center, Washington University School of Medicine, 4625 Lindell Boulevard, St Louis, MO 63108, USA.
J Psychosom Res. 2002 Oct;53(4):897-902. doi: 10.1016/s0022-3999(02)00311-2.
Depression increases the risk of cardiac mortality and morbidity in patients with coronary heart disease (CHD), but the mechanisms that underlie this association remain unclear. This review considers the evidence for several behavioral and physiological mechanisms that might explain how depression increases the risk for incident coronary disease and for subsequent cardiac morbidity and mortality. The candidate mechanisms include: (1). antidepressant cardiotoxicity; (2). association of depression with cardiac risk factors such as cigarette smoking, hypertension, diabetes, and reduced functional capacity; (3). association of depression with greater coronary disease severity; (4). nonadherence to cardiac prevention and treatment regimens; (5). lower heart rate variability (HRV) reflecting altered cardiac autonomic tone; (6). increased platelet aggregation; and (7). inflammatory processes. Despite recent advances in our understanding of these potential mechanisms, further research is needed to determine how depression increases risk for cardiac morbidity and mortality.
抑郁症会增加冠心病（CHD）患者心脏死亡和发病的风险，但这种关联背后的机制仍不清楚。本综述探讨了几种行为和生理机制的证据，这些机制可能解释抑郁症如何增加冠心病发病风险以及随后的心脏发病和死亡风险。候选机制包括：（1）抗抑郁药的心脏毒性；（2）抑郁症与吸烟、高血压、糖尿病和功能能力下降等心脏危险因素的关联；（3）抑郁症与更严重的冠心病的关联；（4）不遵守心脏预防和治疗方案；（5）反映心脏自主神经张力改变的心率变异性（HRV）降低；（6）血小板聚集增加；以及（7）炎症过程。尽管我们对这些潜在机制的理解最近有所进展，但仍需要进一步研究以确定抑郁症如何增加心脏发病和死亡风险。
