Kamphuis Marjolein H, Geerlings Mirjam I, Dekker Jacqueline M, Giampaoli Simona, Nissinen Aulikki, Grobbee Diederick E, Kromhout Daan
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Cardiovasc Prev Rehabil. 2007 Dec;14(6):796-802. doi: 10.1097/HJR.0b013e32829c7d0c.
Depression is associated with an increased risk of cardiovascular diseases (CVD) in vascular patients as well as in the general population. We investigated whether autonomic dysfunction could explain this relationship.
The Finland, Italy and The Netherlands Elderly (FINE) Study is a prospective cohort study.
Depressive symptoms were measured with the Zung Self-rating Depression Scale in 870 men, aged 70-90 years, free of CVD and diabetes in 1990. Resting heart rate was determined from a 15-30-s resting electrocardiogram in The Netherlands and Italy and as pulse rate in Finland. In addition, in The Netherlands, heart-rate variability (HRV) and QTc interval were determined.
At baseline, depressive symptoms were associated with an increase in resting heart rate, and nonsignificantly with low HRV and prolonged QTc interval. After 10 years of follow-up, 233 (27%) men died from CVD. Prospectively, an increase in resting heart rate with 1 SD was associated with an increased risk of cardiovascular mortality [hazard ratio (HR), 1.22; 95% confidence interval (CI), 1.08-1.38]. In addition, low HRV (HR, 0.78; 95% CI, 0.61-1.01) and prolonged QTc interval (HR, 1.28; 95% CI, 1.06-1.53) per SD were associated with cardiovascular mortality. The increased risk of depressive symptoms for cardiovascular mortality (HR, 1.38; 95% CI, 1.21-1.58) did not change after adjustments for several indicators of autonomic dysfunction.
This study suggests that mild depressive symptoms are associated with autonomic dysfunction in elderly men. The increased risk of cardiovascular mortality with increasing magnitude of depressive symptoms could, however, not be explained by autonomic dysfunction.
抑郁症与血管疾病患者以及普通人群中心血管疾病（CVD）风险增加相关。我们研究了自主神经功能障碍是否可以解释这种关系。
芬兰、意大利和荷兰老年人（FINE）研究是一项前瞻性队列研究。
1990年，使用zung自评抑郁量表对870名70 - 90岁、无CVD和糖尿病的男性进行抑郁症状测量。在荷兰和意大利，通过15 - 30秒静息心电图测定静息心率，在芬兰则测定脉搏率。此外，在荷兰还测定了心率变异性（HRV）和QTc间期。
在基线时，抑郁症状与静息心率增加相关，与低HRV和QTc间期延长无显著关联。经过10年随访，233名（27%）男性死于CVD。前瞻性研究表明，静息心率每增加1个标准差与心血管死亡风险增加相关[风险比（HR），1.22；95%置信区间（CI），1.08 - 1.38]。此外，HRV每降低1个标准差（HR，0.78；95% CI，0.61 - 1.01）和QTc间期每延长1个标准差（HR，1.28；95% CI，1.06 - 1.53）均与心血管死亡相关。在对自主神经功能障碍的几个指标进行调整后，抑郁症状导致心血管死亡的风险增加（HR，1.38；95% CI，1.21 - 1.58）并未改变。
本研究表明，轻度抑郁症状与老年男性自主神经功能障碍相关。然而，抑郁症状程度增加导致心血管死亡风险增加这一现象无法用自主神经功能障碍来解释。
