Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands.
J Am Coll Cardiol. 2010 Sep 7;56(11):838-44. doi: 10.1016/j.jacc.2010.03.080.
The purpose of this research was to evaluate the relationship between cognitive and somatic depressive symptoms and cardiovascular prognosis.
Depression in patients with stable coronary heart disease (CHD) is associated with poor cardiac prognosis. Whether certain depressive symptoms are more cardiotoxic than others is unknown.
In the Heart and Soul Study, 1,019 patients with stable CHD were assessed using the Patient Health Questionnaire to determine the presence of the 9 depressive symptoms included in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. The mean age of the patients was 67 years, and 82% were men. A comparison was made on a new cardiovascular event (myocardial infarction, stroke, transient ischemic attack, or congestive heart failure) or death (mean follow-up duration 6.1 +/- 2.0 years) on the basis of cognitive and somatic sum scores and for patients with or without each of those specific depressive symptoms. Demographic characteristics, cardiac risk factors, and cardiac medications were controlled for.
After adjustment for demographic data and cardiac risk factors, each somatic symptom was associated with 14% greater risk for events (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.05 to 1.24; p = 0.002). Fatigue (HR: 1.34; 95% CI: 1.07 to 1.67; p = 0.01), appetite problems (HR: 1.46; 95% CI: 1.12 to 1.91; p = 0.005), and sleeping difficulties (HR: 1.26; 95% CI: 1.00 to 1.58; p = 0.05) were most strongly predictive of cardiovascular events. In contrast, cognitive symptoms (HR: 1.08; 95% CI: 0.99 to 1.17; p = 0.09) were not significantly associated with cardiovascular events.
In patients with stable CHD, somatic symptoms of depression were more strongly predictive of cardiovascular events than cognitive symptoms, although the CIs surrounding these estimates had substantial overlap. These findings are highly consistent with those of previous studies. Further research is needed to understand the pathophysiological processes by which somatic depressive symptoms contribute to prognosis in patients with CHD.
本研究旨在评估认知和躯体抑郁症状与心血管预后之间的关系。
患有稳定型冠心病 (CHD) 的患者的抑郁与不良心脏预后有关。但尚不清楚是否某些抑郁症状比其他症状更具心脏毒性。
在“心脏与灵魂研究”中，对 1019 名稳定型 CHD 患者使用患者健康问卷 (PHQ) 进行评估，以确定包括在精神障碍诊断与统计手册第四版中的 9 种抑郁症状。患者的平均年龄为 67 岁，82%为男性。根据认知和躯体总分，对新发生的心血管事件（心肌梗死、卒 中、短暂性脑缺血发作或充血性心力衰竭）或死亡（平均随访时间为 6.1 ± 2.0 年）进行比较，并比较有或无这些特定抑郁症状的患者。对人口统计学特征、心脏危险因素和心脏药物进行了控制。
在调整人口统计学数据和心脏危险因素后，每个躯体症状与 14%的更大风险事件相关（风险比 [HR]：1.14；95%置信区间 [CI]：1.05 至 1.24；p = 0.002）。疲劳（HR：1.34；95%CI：1.07 至 1.67；p = 0.01）、食欲问题（HR：1.46；95%CI：1.12 至 1.91；p = 0.005）和睡眠困难（HR：1.26；95%CI：1.00 至 1.58；p = 0.05）对心血管事件的预测作用最强。相比之下，认知症状（HR：1.08；95%CI：0.99 至 1.17；p = 0.09）与心血管事件无显著相关性。
在稳定型 CHD 患者中，抑郁的躯体症状比认知症状更能强烈预测心血管事件，尽管这些估计值的 CI 有很大的重叠。这些发现与之前的研究高度一致。需要进一步研究以了解躯体抑郁症状如何通过病理生理过程影响 CHD 患者的预后。
