Department of Nutrition and Epidemiology, Harvard School of Public Health, and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02215, USA.
Stroke. 2011 Oct;42(10):2770-5. doi: 10.1161/STROKEAHA.111.617043. Epub 2011 Aug 11.
Depression has been associated with an increased risk of coronary heart disease, but prospective data for the association with stroke are limited.
We followed-up 80 574 women aged 54 to 79 years in Nurses' Health Study without a history of stroke from 2000 to 2006. Depressive symptoms were assessed at multiple time points by a Mental Health Index score (1992, 1996, and 2000), and clinical significant depressive symptoms were defined as a score≤52. Antidepressant medication use was asked biennially beginning in 1996, and physician-diagnosed depression was reported biennially beginning in 2000. Depression was defined as currently reporting or having a history of any of these 3 conditions.
During 6 years of follow-up, 1033 incident strokes were documented (538 ischemic, 124 hemorrhagic, and 371 unknown strokes). Having a history of depression was associated with a multivariate-adjusted hazard ratio (HR) of 1.29 (95% confidence interval [CI], 1.13-1.48) for total stroke. Women who used antidepressant medications were at increased risk for stroke, whether they also had a Mental Health Index score≤52 or diagnosed depression (HR, 1.39; 95% CI, 1.15-1.69) or not (HR, 1.31; 95% CI, 1.03-1.67). Furthermore, for each cycle, participants who reported current depression had an increased risk of stroke (HR, 1.41; 95% CI, 1.18-1.67), whereas individuals who only had a history of depression were at nonsignificantly elevated risk (HR, 1.23; 95% CI, 0.97-1.56) compared with women who never reported a diagnosis of depression or antidepressant medication use.
Our results suggest that depression is associated with a moderately increased risk of subsequent stroke.
抑郁与冠心病风险增加相关，但前瞻性数据显示其与中风的关联有限。
我们对无中风病史的 80574 名年龄在 54 至 79 岁的护士健康研究参与者进行了随访，随访时间为 2000 年至 2006 年。通过心理健康指数评分（1992 年、1996 年和 2000 年）在多个时间点评估抑郁症状，临床显著抑郁症状定义为评分≤52。从 1996 年开始，每两年询问一次抗抑郁药物的使用情况，从 2000 年开始，每两年报告一次医生诊断的抑郁症。抑郁被定义为目前报告或有上述 3 种情况之一的病史。
在 6 年的随访期间，共记录到 1033 例中风事件（538 例缺血性中风、124 例出血性中风和 371 例未知类型中风）。有抑郁病史的参与者发生总中风的多变量调整后的风险比（HR）为 1.29（95%置信区间[CI]，1.13-1.48）。服用抗抑郁药物的女性发生中风的风险增加，无论她们的心理健康指数评分是否≤52 或是否被诊断为抑郁（HR，1.39；95%CI，1.15-1.69）或没有（HR，1.31；95%CI，1.03-1.67）。此外，每个周期内，报告当前患有抑郁的参与者中风风险增加（HR，1.41；95%CI，1.18-1.67），而仅患有抑郁病史的参与者风险升高不显著（HR，1.23；95%CI，0.97-1.56）与从未报告过抑郁症或抗抑郁药物使用史的女性相比。
我们的研究结果表明，抑郁与中风后风险中度增加相关。
