Department of Surgery, University of California San Francisco, San Francisco, CA (S.M.G., J.H.) ; Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA (S.M.G.).
J Am Heart Assoc. 2012 Aug;1(4):e002667. doi: 10.1161/JAHA.112.002667. Epub 2012 Aug 24.
Depression is known to increase the risk of coronary artery disease, but few studies have evaluated the association between depression and peripheral artery disease (PAD). We examined the association of depression with PAD and evaluated potential mediators of this association.
We used data from the Heart and Soul Study, a prospective cohort of 1024 men and women with coronary artery disease recruited in 2000-2002 and followed for a mean of 7.2±2.6 years. Depressive symptoms were assessed with the validated 9-item Patient Health Questionnaire. Prevalent PAD at baseline was determined by self-report. Prospective PAD events were adjudicated on the basis of review of medical records. We used logistic regression and Cox proportional-hazards models to estimate the independent associations of depressive symptoms with prevalent PAD and subsequent PAD events. At baseline, 199 patients (19%) had depressive symptoms (Patient Health Questionnaire ≥10). Prevalent PAD was reported by 12% of patients with depression and 7% of those without depression (base model adjusted for age and sex: odds ratio 1.79, 95% confidence interval 1.06-3.04, P=0.03; full model adjusted for comorbidities, medications, PAD risk factors, inflammation, and health behaviors: odds ratio 1.59, 95% confidence interval 0.90-2.83, P=0.11). During follow-up, PAD events occurred in 7% of patients with depression and 5% of those without depression (base model adjusted for age and sex: hazard ratio 2.09, 95% confidence interval 1.09-4.00, P=0.03; full model adjusted for comorbidities, medications, PAD risk factors, inflammation, and health behaviors: hazard ratio 1.33, 95% confidence interval 0.65-2.71, P=0.44). Factors explaining >5% of the association between depression and incident PAD events included race/ethnicity, diabetes, congestive heart failure, high-density lipoprotein, triglyceride levels, serum creatinine, inflammation, smoking, and levels of physical activity.
Depressive symptoms were associated with a greater risk of PAD. Because the association was explained partly by modifiable risk factors, our findings suggest that more aggressive treatment of these risk factors could reduce the excess risk of PAD associated with depression. (J Am Heart Assoc. 2012;1:e002667 doi: 10.1161/JAHA.112.002667.).
已知抑郁症会增加患冠状动脉疾病的风险，但很少有研究评估抑郁症与外周动脉疾病（PAD）之间的关系。我们研究了抑郁症与 PAD 的关系，并评估了这种关系的潜在中介因素。
我们使用了 2000-2002 年招募的 1024 名患有冠状动脉疾病的男性和女性的前瞻性队列研究（心脏与灵魂研究）的数据，平均随访 7.2±2.6 年。使用经过验证的 9 项患者健康问卷评估抑郁症状。根据医疗记录审查确定基线时的 PAD 患病率。我们使用逻辑回归和 Cox 比例风险模型来估计抑郁症状与 PAD 患病率和随后的 PAD 事件之间的独立关联。基线时，199 名患者（19%）有抑郁症状（患者健康问卷≥10）。12%的抑郁症患者和 7%的非抑郁症患者报告有 PAD（基础模型校正年龄和性别后：比值比 1.79，95%置信区间 1.06-3.04，P=0.03；完全模型校正合并症、药物、PAD 危险因素、炎症和健康行为后：比值比 1.59，95%置信区间 0.90-2.83，P=0.11）。在随访期间，7%的抑郁症患者和 5%的非抑郁症患者发生 PAD 事件（基础模型校正年龄和性别后：风险比 2.09，95%置信区间 1.09-4.00，P=0.03；完全模型校正合并症、药物、PAD 危险因素、炎症和健康行为后：风险比 1.33，95%置信区间 0.65-2.71，P=0.44）。可以解释抑郁与 PAD 事件之间关联超过 5%的因素包括种族/民族、糖尿病、充血性心力衰竭、高密度脂蛋白、甘油三酯水平、血清肌酐、炎症、吸烟和体力活动水平。
抑郁症状与 PAD 风险增加相关。由于这种关联部分可以通过可改变的危险因素来解释，我们的研究结果表明，更积极地治疗这些危险因素可能会降低与抑郁相关的 PAD 风险增加。
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