共病抑郁和焦虑症状作为心血管事件的预测因素：美国国立心肺血液研究所资助的女性缺血综合征评估（WISE）研究结果
Comorbid depression and anxiety symptoms as predictors of cardiovascular events: results from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study.
作者信息
Rutledge Thomas, Linke Sarah E, Krantz David S, Johnson B Delia, Bittner Vera, Eastwood Jo-Ann, Eteiba Wafia, Pepine Carl J, Vaccarino Viola, Francis Jennifer, Vido Diane A, Merz C Noel Bairey
机构信息
VA San Diego Healthcare Syste, University of California, San Diego, San Diego, California, USA.
出版信息
Psychosom Med. 2009 Nov;71(9):958-64. doi: 10.1097/PSY.0b013e3181bd6062. Epub 2009 Oct 15.
OBJECTIVE
To study the independent and interactive effects of depression and anxiety symptoms as predictors of cardiovascular disease (CVD) events in a sample of women with suspected myocardial ischemia. Symptoms of depression and anxiety overlap strongly and are independent predictors of CVD events. Although these symptoms commonly co-occur in medical patients, little is known about combined effects of depression and anxiety on CVD risk.
METHOD
A total of 489 women completed a baseline protocol including coronary angiogram, CVD risk factor assessment, and questionnaire-based measures of depression and anxiety symptoms, using the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI), respectively. Participants were followed for a median 5.9 years to track the prevalence of CVD events (stroke, myocardial infarction, heart failure, and CVD-related mortality). We tested the BDI x STAI interaction effect in addition to the BDI and STAI main effects.
RESULTS
Seventy-five women (15.3% of sample) experienced a CVD event, of which 18 were deaths attributed to cardiovascular causes. Results using Cox regression indicated a significant BDI x STAI interaction effect in the prediction of CVD events (p = .02) after covariate adjustment. Simple effect analyses indicated that depression scores were significant predictors of CVD events among women with low anxiety scores (hazard ratio [HR] = 2.3 [in standard deviation units]; 95% Confidence Interval [CI] = 1.3-3.9; p = .005) but not among women with higher levels of anxiety (HR = 0.99; 95% CI = 0.70-1.4; p = .95).
CONCLUSION
Among women with suspected myocardial ischemia, the value of depression symptoms for predicting CVD events varied by the severity of comorbid anxiety. These results suggest that the clinical utility of depression measures may be improved by using them in combination with measures of anxiety.
目的
在疑似心肌缺血的女性样本中，研究抑郁症状和焦虑症状作为心血管疾病（CVD）事件预测因素的独立及交互作用。抑郁症状和焦虑症状有很强的重叠性，且都是CVD事件的独立预测因素。尽管这些症状在医学患者中常同时出现，但对于抑郁和焦虑对CVD风险的联合作用知之甚少。
方法
共有489名女性完成了一项基线方案，包括冠状动脉造影、CVD风险因素评估，以及分别使用贝克抑郁量表（BDI）和状态-特质焦虑量表（STAI）进行的基于问卷的抑郁和焦虑症状测量。对参与者进行了为期5.9年的中位数随访，以追踪CVD事件（中风、心肌梗死、心力衰竭和CVD相关死亡率）的发生率。除了BDI和STAI的主效应外，我们还测试了BDI×STAI的交互作用。
结果
75名女性（样本的15.3%）发生了CVD事件，其中18例死于心血管原因。使用Cox回归的结果表明，在进行协变量调整后，BDI×STAI的交互作用在预测CVD事件方面具有显著性（p = 0.02）。简单效应分析表明，抑郁评分在焦虑评分低的女性中是CVD事件的显著预测因素（风险比[HR] = 2.3[以标准差为单位]；95%置信区间[CI] = 1.3 - 3.9；p = 0.005），但在焦虑水平较高的女性中不是（HR = 0.99；95%CI = 0.70 - 1.4；p = 0.95）。
结论
在疑似心肌缺血的女性中，抑郁症状对预测CVD事件的价值因共病焦虑的严重程度而异。这些结果表明，将抑郁测量与焦虑测量结合使用可能会提高其临床效用。
Zotero 插件