Rutledge Thomas, Reis Steven E, Olson Marian B, Owens Jane, Kelsey Sheryl F, Pepine Carl J, Mankad Sunil, Rogers William J, Merz C Noel Bairey, Sopko George, Cornell Carol E, Sharaf Barry, Matthews Karen A, Vaccarino Viola
Department of Psychiatry, VA San Diego Healthcare System and University of California, San Diego, CA 92161, USA.
Arch Gen Psychiatry. 2006 Aug;63(8):874-80. doi: 10.1001/archpsyc.63.8.874.
Depression is associated with clinical events and premature mortality among patients with established coronary artery disease (CAD). Typically, however, studies in this area focus only on baseline symptom severity and lack any data concerning symptom duration or symptom history.
To describe and compare the relationships between 2 measures of depression-assessed in the form of depression symptom severity and reported treatment history-with atherosclerosis risk factors and major clinical events in a sample of women with suspected myocardial ischemia.
Follow-up study of women who completed a diagnostic CAD protocol, including cardiac symptoms, coronary angiography, ischemic testing, and assessments of depression symptom severity and reported treatment history.
The Women's Ischemia Syndrome Evaluation (WISE), a National Heart, Lung, and Blood Institute (NHLBI)-sponsored multicenter study assessing cardiovascular function using state-of-the-art techniques in women referred for coronary angiography to evaluate chest pain or suspected myocardial ischemia.
Five hundred five women (mean age, 53.4 years) enrolled in WISE and followed up for a mean of 4.9 years.
Incidence of cardiac events, including myocardial infarction, stroke, and heart failure, and total mortality.
Relative to those with no or less stable depression symptoms, women with elevated depression symptoms and a reported treatment history showed higher rates of smoking, hypertension, and poorer education and an increased incidence of death and cardiac events (multivariate-adjusted risk ratio, 3.1; 95% confidence interval, 1.5-6.3; P = .001).
Among women with suspected myocardial ischemia, a combination of depressive symptom severity and treatment history was a strong predictor of an elevated CAD risk profile and increased risk of cardiac events compared with those without depression or with only 1 of the 2 measured depression markers. These findings reinforce the importance of assessing mental health factors in women at elevated CAD risk. Focusing only on baseline depression symptom severity may provide an incomplete picture of CAD risk.
抑郁症与已确诊冠状动脉疾病（CAD）患者的临床事件及过早死亡相关。然而，该领域的研究通常仅关注基线症状严重程度，缺乏有关症状持续时间或症状史的任何数据。
以抑郁症症状严重程度和报告的治疗史形式评估的两种抑郁症测量指标，描述并比较其与疑似心肌缺血女性样本中的动脉粥样硬化危险因素及主要临床事件之间的关系。
对完成诊断性CAD方案的女性进行随访研究，该方案包括心脏症状、冠状动脉造影、缺血测试以及抑郁症症状严重程度评估和报告的治疗史。
女性缺血综合征评估（WISE），一项由美国国立心肺血液研究所（NHLBI）赞助的多中心研究，使用先进技术评估因胸痛或疑似心肌缺血而接受冠状动脉造影的女性的心血管功能。
505名女性（平均年龄53.4岁）参与WISE研究并平均随访4.9年。
心脏事件（包括心肌梗死、中风和心力衰竭）的发生率以及总死亡率。
与抑郁症症状无或较不稳定的女性相比，抑郁症症状严重且有治疗史的女性吸烟率、高血压患病率更高，受教育程度更低，死亡和心脏事件发生率更高（多变量调整风险比为3.1；95%置信区间为1.5 - 6.3；P = 0.001）。
在疑似心肌缺血的女性中，与无抑郁症或仅具有两种测量的抑郁症标志物之一的女性相比，抑郁症状严重程度和治疗史相结合是CAD风险升高和心脏事件风险增加的有力预测指标。这些发现强化了评估CAD风险升高女性心理健康因素的重要性。仅关注基线抑郁症状严重程度可能无法全面了解CAD风险。
