Hamer Mark, Molloy Gerard J, Stamatakis Emmanuel
Department of Epidemiology and Public Health, University College, London, United Kingdom.
J Am Coll Cardiol. 2008 Dec 16;52(25):2156-62. doi: 10.1016/j.jacc.2008.08.057.
This study sought to estimate the extent to which behavioral and pathophysiological risk factors account for the association between psychological distress and incident cardiovascular events.
The intermediate processes through which psychological distress increases the risk of cardiovascular disease (CVD) are incompletely understood. An understanding of these processes is important for treating psychological distress in an attempt to reduce CVD risk.
In a prospective study of 6,576 healthy men and women (ages 50.9 +/- 13.1 years), we measured psychological distress (using the 12-item version of the General Health Questionnaire >or=4) and behavioral (smoking, alcohol, physical activity) and pathophysiological (C-reactive protein, fibrinogen, total and high-density lipoprotein cholesterol, obesity, hypertension) risk factors at baseline. The main outcome was CVD events (hospitalization for nonfatal myocardial infarction, coronary artery bypass, angioplasty, stroke, heart failure, and CVD-related mortality).
Cigarette smoking, physical activity, alcohol intake, C-reactive protein, and hypertension were independently associated with psychological distress. There were 223 incident CVD events (63 fatal) over an average follow-up of 7.2 years. The risk of CVD increased in relation to presence of psychological distress in age- and sex-adjusted models (hazard ratio: 1.54, 95% confidence interval: 1.09 to 2.18, p = 0.013). In models that were adjusted for potential mediators, behavioral factors explained the largest proportion of variance ( approximately 65%), whereas pathophysiological factors accounted for a modest amount (C-reactive protein approximately 5.5%, hypertension, approximately 13%).
The association between psychological distress and CVD risk is largely explained by behavioral processes. Therefore, treatment of psychological distress that aims to reduce CVD risk should primarily focus on health behavior change.
本研究旨在评估行为和病理生理风险因素在心理困扰与心血管事件发生之间的关联中所占的比例。
心理困扰增加心血管疾病（CVD）风险的中间过程尚未完全明确。了解这些过程对于治疗心理困扰以降低CVD风险至关重要。
在一项对6576名健康男性和女性（年龄50.9±13.1岁）的前瞻性研究中，我们在基线时测量了心理困扰（使用12项一般健康问卷，得分≥4）以及行为（吸烟、饮酒、身体活动）和病理生理（C反应蛋白、纤维蛋白原、总胆固醇和高密度脂蛋白胆固醇、肥胖、高血压）风险因素。主要结局是CVD事件（非致命性心肌梗死、冠状动脉搭桥术、血管成形术、中风、心力衰竭的住院治疗以及与CVD相关的死亡率）。
吸烟、身体活动、饮酒、C反应蛋白和高血压与心理困扰独立相关。在平均7.2年的随访期间，共发生223例CVD事件（63例死亡）。在年龄和性别调整模型中，CVD风险随着心理困扰的存在而增加（风险比：1.54，95%置信区间：1.09至2.18，p = 0.013）。在对潜在中介因素进行调整的模型中，行为因素解释了最大比例的方差（约65%），而病理生理因素占比适中（C反应蛋白约5.5%，高血压约13%）。
心理困扰与CVD风险之间的关联主要由行为过程解释。因此，旨在降低CVD风险的心理困扰治疗应主要关注健康行为改变。
