Harvard Medical School, TMEC, 260 Longwood Avenue, Boston, MA 02115, USA.
Int J Cardiol. 2009 Feb 6;132(1):30-7. doi: 10.1016/j.ijcard.2008.10.002. Epub 2008 Nov 11.
Traditional cardiac risk factors, such as smoking, hypertension and obesity, are widely accepted contributors to the onset and progression of cardiovascular disease (CVD), one of the foremost causes of morbidity and mortality worldwide. Largely overlooked, however, is the impact of mental health on cardiac disease. From extensive MEDLINE and PsycINFO searches, we have reviewed the association between specific psychiatric disorders and CVD-related morbidity and mortality, the efficacy and safety of their treatments, and plausible behavioral and biological mechanism through which these associations may occur. The preponderance of evidence suggests that depression, anxiety disorders, bipolar disorder and schizophrenia are all important cardiac risk factors, and patients with these disorders are at significantly higher risk for cardiac morbidity and mortality than are their counterparts in the general population. Antidepressants, antipsychotics, mood stabilizers and benzodiazepines are effective therapeutic interventions, and many are safe to use in cardiac populations. Some, such as selective serotonin reuptake inhibitors and atypical antipsychotics, may even improve cardiac outcomes in healthy individuals and patients with CVD, although more work is needed to confirm this hypothesis. A combination of behavioral and biological mechanisms underlies the association between cardiac disease and mental illness, many of which are shared across disorders. With further research, it may be learned that psychiatric treatments definitively reverse the detrimental effects of mental illness on cardiac health. Currently, however, the challenge lies in raising awareness of mental health issues in cardiac patients, so that basic but critical treatments may be initiated in this population.
传统的心脏危险因素，如吸烟、高血压和肥胖，被广泛认为是心血管疾病（CVD）发病和进展的主要原因之一，CVD 是全球发病率和死亡率的首要原因之一。然而，心理健康对心脏病的影响在很大程度上被忽视了。我们通过广泛的 MEDLINE 和 PsycINFO 搜索，回顾了特定精神障碍与 CVD 相关发病率和死亡率之间的关联、其治疗方法的疗效和安全性，以及这些关联可能发生的合理行为和生物学机制。大量证据表明，抑郁症、焦虑障碍、双相情感障碍和精神分裂症都是重要的心脏危险因素，患有这些疾病的患者发生心脏发病率和死亡率的风险明显高于普通人群。抗抑郁药、抗精神病药、心境稳定剂和苯二氮䓬类药物都是有效的治疗干预措施，其中许多药物在心脏人群中使用是安全的。一些药物，如选择性 5-羟色胺再摄取抑制剂和非典型抗精神病药，甚至可能改善健康个体和 CVD 患者的心脏预后，尽管需要更多的工作来证实这一假设。心脏疾病和精神疾病之间的关联有多种行为和生物学机制，其中许多机制在不同的疾病中都存在。随着进一步的研究，人们可能会了解到精神科治疗可以明确逆转精神疾病对心脏健康的不利影响。然而，目前的挑战在于提高心脏患者对心理健康问题的认识，以便在这一人群中开始进行基本但关键的治疗。
