O'Connor Christopher M, Jiang Wei, Kuchibhatla Maragatha, Mehta Rajendra H, Clary Greg L, Cuffe Michael S, Christopher Eric J, Alexander Jude D, Califf Robert M, Krishnan Ranga R
Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, 2400 N Pratt St, Box 3356, Durham, NC 27705, USA.
Arch Intern Med. 2008 Nov 10;168(20):2232-7. doi: 10.1001/archinte.168.20.2232.
Recent studies suggest that the use of antidepressants may be associated with increased mortality in patients with cardiac disease. Because depression has also been shown to be associated with increased mortality in these patients, it remains unclear if this association is attributable to the use of antidepressants or to depression.
To evaluate the association of long-term mortality with antidepressant use and depression, we studied 1006 patients aged 18 years or older with clinical heart failure and an ejection fraction of 35% or less (62% with ischemic disease) between March 1997 and June 2003. The patients were followed up for vital status annually thereafter. Depression status, which was assessed by the Beck Depression Inventory (BDI) scale and use of antidepressants, was prospectively collected. The main outcome of interest was long-term mortality.
Of the study patients, 30.0% were depressed (defined by a BDI score > or =10) and 24.2% were taking antidepressants (79.6% of these patients were taking selective serotonin reuptake inhibitors [SSRIs] only). The vital status was obtained from all participants at an average follow-up of 972 (731) (mean [SD]) days. During this period, 42.7% of the participants died. Overall, the use of antidepressants (unadjusted hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.03-1.69) or SSRIs only (unadjusted HR, 1.32; 95% CI, 0.99-1.74) was associated with increased mortality. However, the association between antidepressant use (HR, 1.24; 95% CI, 0.94-1.64) and increased mortality no longer existed after depression and other confounders were controlled for. Nonetheless, depression remained associated with increased mortality (HR, 1.33; 95% CI, 1.07-1.66). Similarly, depression (HR, 1.34; 95% CI, 1.08-1.68) rather than SSRI use (HR, 1.10; 95% CI, 0.81-1.50) was independently associated with increased mortality after adjustment.
Our findings suggest that depression (defined by a BDI score > or =10), but not antidepressant use, is associated with increased mortality in patients with heart failure.
近期研究表明，使用抗抑郁药可能与心脏病患者死亡率增加有关。由于抑郁症也已被证明与这些患者的死亡率增加有关，因此尚不清楚这种关联是归因于抗抑郁药的使用还是抑郁症。
为了评估长期死亡率与抗抑郁药使用和抑郁症之间的关联，我们研究了1997年3月至2003年6月期间1006例年龄在18岁及以上、患有临床心力衰竭且射血分数为35%或更低（62%患有缺血性疾病）的患者。此后每年对患者进行生命状态随访。前瞻性收集通过贝克抑郁量表（BDI）评估的抑郁状态和抗抑郁药的使用情况。主要关注的结果是长期死亡率。
在研究患者中，30.0%患有抑郁症（定义为BDI评分≥10），24.2%正在服用抗抑郁药（这些患者中79.6%仅服用选择性5-羟色胺再摄取抑制剂[SSRI]）。在平均972（731）（均值[标准差]）天的随访中，从所有参与者处获得了生命状态。在此期间，42.7%的参与者死亡。总体而言，使用抗抑郁药（未调整危险比[HR]，1.32；95%置信区间[CI]，1.03 - 1.69）或仅使用SSRI（未调整HR，1.32；95% CI，0.99 - 1.74）与死亡率增加相关。然而，在控制抑郁症和其他混杂因素后，抗抑郁药使用与死亡率增加之间的关联（HR，1.24；95% CI，0.94 - 1.64）不再存在。尽管如此，抑郁症仍然与死亡率增加相关（HR，1.33；95% CI，1.07 - 1.66）。同样，调整后抑郁症（HR，1.34；95% CI，1.08 - 1.68）而非SSRI使用（HR，1.10；95% CI，0.81 - 1.50）与死亡率增加独立相关。
我们的研究结果表明，抑郁症（定义为BDI评分≥10）而非抗抑郁药的使用与心力衰竭患者死亡率增加有关。
