维生素 D 水平与一般心血管人群中抑郁事件的关联。

Association of vitamin D levels with incident depression among a general cardiovascular population.

机构信息

Intermountain Medical Center, Murray, UT 84157, USA.

出版信息

Am Heart J. 2010 Jun;159(6):1037-43. doi: 10.1016/j.ahj.2010.03.017.

DOI:10.1016/j.ahj.2010.03.017

PMID:20569717

Abstract

BACKGROUND

Depression is associated with cardiovascular (CV) disease, and it has been hypothesized that vitamin (vit)D deficiency may be associated with depression and a contributing factor to excess CV events. Therefore, we evaluated whether there is an association between vitD and incident depression among a CV population.

METHODS

Patients (N = 7,358) > or =50 years of age, with a CV diagnosis (coronary artery disease, myocardial infarction, congestive heart failure, cerebrovascular accident, transient ischemic accident, atrial fibrillation, or peripheral vascular disease), no prior depression diagnosis, and a measured vitD level were studied. Vitamin D (ng/mL) was stratified into 4 categories: >50 (optimal [O] n = 367), 31 to 50 (normal [N] n = 2,264), 16 to 30 (low [L] n = 3,402), and > or =15 (very low [VL] n = 1,325). Depression was defined by International Classification of Diseases, Ninth Edition, codes: 296.2 to 296.36, 311. VitD categories were evaluated by Cox hazard regression with adjustment by standard CV risk factors.

RESULTS

Age averaged 73.1 +/- 10.2 years, and 58.8% were female. When compared to O, VL, L, and N were associated with depression (adjusted: VL, hazard ratio [HR] 2.70 [1.35-5.40], P = .005; L, HR 2.15 [1.10-4.21], P = .03; N, HR 1.95 [0.99-3.87], P = .06). This association remained even after adjustment by parathyroid hormone levels. Parathyroid hormone was significantly associated with depression, however, became nonsignificant after adjustment by vitD. Winter (December-February) enhanced this association. Significant associations remained when stratifications were made by age (<65, > or =65), sex, and diabetes, although the associations among those age > or =65 and male sex were enhanced.

CONCLUSION

Among a CV population > or =50 years with no history of depression, vitD levels were shown to be associated with incident depression after vitD draw. This study strengthens the hypothesis of the association between vitD and depression.

摘要

背景

抑郁症与心血管（CV）疾病相关，据推测，维生素（vit）D 缺乏可能与抑郁症有关，也是导致 CV 事件过多的一个因素。因此，我们评估了 CV 人群中 vitD 与新发抑郁症之间是否存在关联。

方法

研究纳入年龄≥50 岁、有 CV 诊断（冠状动脉疾病、心肌梗死、充血性心力衰竭、脑血管意外、短暂性脑缺血发作、心房颤动或外周血管疾病）、无既往抑郁症诊断且有 vitD 水平检测结果的患者（N=7358）。vitD（ng/mL）分为 4 个等级：>50（最佳[O]，n=367）、31-50（正常[N]，n=2264）、16-30（低[L]，n=3402）和≥15（极低[VL]，n=1325）。抑郁症通过国际疾病分类，第九版（ICD-9）编码：296.2-296.36、311 进行定义。通过 Cox 比例风险回归评估 vitD 等级，并用标准 CV 风险因素进行调整。

结果

平均年龄为 73.1±10.2 岁，58.8%为女性。与 O 相比，VL、L 和 N 与抑郁症相关（校正：VL，风险比[HR]2.70[1.35-5.40]，P=0.005；L，HR2.15[1.10-4.21]，P=0.03；N，HR1.95[0.99-3.87]，P=0.06）。这种关联在调整甲状旁腺激素水平后仍然存在。甲状旁腺激素与抑郁症显著相关，但在调整 vitD 水平后变得不显著。冬季（12 月-2 月）增强了这种关联。在按年龄（<65、≥65）、性别和糖尿病进行分层时，仍存在显著相关性，尽管≥65 岁和男性的相关性增强。