Rutledge Thomas, Reis Steven E, Olson Marian, Owens Jane, Kelsey Sheryl F, Pepine Carl J, Mankad Sunil, Rogers William J, Sopko George, Cornell Carol E, Sharaf Barry, Merz C Noel Bairey
University of California, San Diego, CA, USA.
Psychosom Med. 2006 Mar-Apr;68(2):217-23. doi: 10.1097/01.psy.0000195751.94998.e3.
Depression is a robust predictor of cardiovascular risk. In this study, we examined the association between depression measured in terms of symptom severity and treatment history, cardiac symptom presentation, and clinical outcomes among a sample of women with suspected myocardial ischemia.
Seven hundred fifty women with chest pain, mean age 53.4, completed a diagnostic protocol including depression measures, coronary angiogram, ischemia testing, and coronary disease risk factor assessment. Five hundred five participants also completed the Beck Depression Inventory. We further tracked participants over a mean 2.3-year period to evaluate subsequent cardiac events, hospitalization, and mortality.
Depression treatment history and current symptom severity were differentially associated with cardiac symptoms and outcomes. Both measures were reliably associated with coronary artery disease (CAD) risk factors and more severe cardiac symptoms. Depression symptom severity was linked to an increased mortality risk over follow-up (RR = 1.05; 95% CI, 1.01-1.09), whereas depression treatment history predicted an increased risk of hospitalization (RR = 1.3; 95% CI, 1.02-1.6), less severe CAD from angiogram, and a reduced likelihood of a positive ischemia test.
Among a sample of women with suspected myocardial ischemia, depression was associated with cardiac symptoms and health outcomes over follow-up. The findings extend the range of depression effects by demonstrating relationships within a sample of women experiencing symptoms of myocardial ischemia but showing a relative absence of flow limiting coronary stenoses. Depression measurements can assist the clinician in evaluating cardiac symptom presentation and cardiovascular risk status in women.
抑郁症是心血管疾病风险的有力预测指标。在本研究中，我们调查了以症状严重程度和治疗史衡量的抑郁症与疑似心肌缺血女性样本中的心脏症状表现及临床结局之间的关联。
750名胸痛女性，平均年龄53.4岁，完成了一项诊断方案，包括抑郁症测量、冠状动脉造影、缺血检测以及冠心病危险因素评估。505名参与者还完成了贝克抑郁量表。我们进一步对参与者进行了平均2.3年的跟踪，以评估后续的心脏事件、住院情况和死亡率。
抑郁症治疗史和当前症状严重程度与心脏症状及结局存在不同程度的关联。这两项指标均与冠状动脉疾病（CAD）危险因素及更严重的心脏症状密切相关。抑郁症状严重程度与随访期间死亡率增加相关（风险比[RR]=1.05；95%置信区间[CI]，1.01 - 1.09），而抑郁症治疗史则预示着住院风险增加（RR = 1.3；95% CI，1.02 - 1.6）、血管造影显示CAD病情较轻以及缺血检测呈阳性的可能性降低。
在疑似心肌缺血的女性样本中，抑郁症与随访期间的心脏症状及健康结局相关。这些发现通过在出现心肌缺血症状但相对不存在限流性冠状动脉狭窄的女性样本中证明两者的关系，扩展了抑郁症影响的范围。抑郁症测量有助于临床医生评估女性的心脏症状表现和心血管风险状况。
