Wassertheil-Smoller Sylvia, Shumaker Sally, Ockene Judith, Talavera Greg A, Greenland Philip, Cochrane Barbara, Robbins John, Aragaki Aaron, Dunbar-Jacob Jacqueline
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Arch Intern Med. 2004 Feb 9;164(3):289-98. doi: 10.1001/archinte.164.3.289.
Subclinical depression, often clinically unrecognized, may pose increased risk of cardiovascular disease. Few studies have prospectively investigated cardiovascular events related to depression in older women. We describe prevalence, cardiovascular correlates, and relationship to subsequent cardiovascular events of depressive symptoms among generally healthy postmenopausal women.
The Women's Health Initiative Observational Study followed up 93 676 women for an average of 4.1 years. Depression was measured at baseline with a short form of the Center for Epidemiological Studies Depression Scale. Risks of cardiovascular disease (CVD) events were estimated from Cox proportional hazards models adjusting for multiple demographic, clinical, and risk factor covariates.
Current depressive symptoms above the screening cutoff point were reported by 15.8% of women. Depression was significantly related to CVD risk and comorbidity (odds ratios ranging from 1.12 for hypertension to 1.60 for history of stroke or angina). Among women with no history of CVD, depression was an independent predictor of CVD death (relative risk, 1.50) and all-cause mortality (relative risk, 1.32) after adjustment for age, race, education, income, diabetes, hypertension, smoking, high cholesterol level requiring medication, body mass index, and physical activity. Taking antidepressant medications did not alter the depression-associated risks associated.
A large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD death and all-cause mortality, even after controlling for established CVD risk factors. Whether early recognition and treatment of subclinical depression will lower CVD risk remains to be determined in clinical trials.
亚临床抑郁症通常在临床上未被识别，可能会增加心血管疾病的风险。很少有研究前瞻性地调查老年女性中与抑郁症相关的心血管事件。我们描述了一般健康的绝经后女性中抑郁症状的患病率、心血管相关性以及与随后心血管事件的关系。
女性健康倡议观察性研究对93676名女性进行了平均4.1年的随访。在基线时用流行病学研究中心抑郁量表的简表测量抑郁症。根据Cox比例风险模型估计心血管疾病（CVD）事件的风险，并对多种人口统计学、临床和风险因素协变量进行调整。
15.8%的女性报告目前的抑郁症状高于筛查临界值。抑郁症与CVD风险和合并症显著相关（优势比从高血压的1.12到中风或心绞痛病史的1.60不等）。在无CVD病史的女性中，在调整年龄、种族、教育程度、收入、糖尿病、高血压、吸烟、需要药物治疗的高胆固醇水平、体重指数和身体活动后，抑郁症是CVD死亡（相对风险，1.50）和全因死亡率（相对风险，1.32）的独立预测因素。服用抗抑郁药物并未改变与抑郁症相关的风险。
很大一部分老年女性报告的抑郁症状水平与CVD死亡和全因死亡率增加显著相关，即使在控制了已确定的CVD风险因素之后。亚临床抑郁症的早期识别和治疗是否会降低CVD风险仍有待临床试验确定。
