在糖尿病减肥临床试验 LOOK AHEAD（糖尿病健康行动）中，对心血管疾病危险因素、抑郁症状和抗抑郁药物使用进行了为期 4 年的分析。
Four-year analysis of cardiovascular disease risk factors, depression symptoms, and antidepressant medicine use in the Look AHEAD (Action for Health in Diabetes) clinical trial of weight loss in diabetes.
机构信息
Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Diabetes Care. 2013 May;36(5):1088-94. doi: 10.2337/dc12-1871. Epub 2013 Jan 28.
OBJECTIVE
To study the association of depressive symptoms or antidepressant medicine (ADM) use with subsequent cardiovascular disease (CVD) risk factor status in the Look AHEAD (Action for Health in Diabetes) trial of weight loss in type 2 diabetes.
RESEARCH DESIGN AND METHODS
Participants (n = 5,145; age [mean ± SD] 58.7 ± 6.8 years; BMI 35.8 ± 5.8 kg/m(2)) in two study arms (intensive lifestyle [ILI], diabetes support and education [DSE]) completed the Beck Depression Inventory (BDI), reported ADM use, and were assessed for CVD risk factors at baseline and annually for 4 years. Risk factor-positive status was defined as current smoking, obesity, HbA1c >7.0% or insulin use, and blood pressure or cholesterol not at levels recommended by expert consensus panel or medicine to achieve recommended levels. Generalized estimating equations assessed within-study arm relationships of elevated BDI score (≥11) or ADM use with subsequent year CVD risk status, controlled for demographic variables, CVD history, diabetes duration, and prior CVD risk status.
RESULTS
Prior year elevated BDI was associated with subsequent CVD risk factor-positive status for the DSE arm (A1C [odds ratio 1.30 (95% CI 1.09-1.56)]; total cholesterol [0.80 (0.65-1.00)]; i.e., protective from high total cholesterol) and the ILI arm (HDL [1.40 (1.12-1.75)], triglyceride [1.28 (1.00-1.64)]). Prior year ADM use predicted subsequent elevated CVD risk status for the DSE arm (HDL [1.24 (1.03-1.50)], total cholesterol [1.28 (1.05-1.57)], current smoking [1.73 (1.04-2.88)]) and for the ILI arm (A1C [1.25 (1.08-1.46)], HDL [1.32 (1.11-1.58)], triglycerides [1.75 (1.43-2.14)], systolic blood pressure [1.39 (1.11-1.74)], and obesity [1.46 (1.22-2.18)]).
CONCLUSIONS
Aggressive monitoring of CVD risk in diabetic patients with depressive symptoms or who are treated with ADM may be warranted.
目的
在 2 型糖尿病减肥的 LOOK AHEAD（糖尿病健康行动）试验中，研究抑郁症状或抗抑郁药物（ADM）使用与随后心血管疾病（CVD）风险因素状况之间的关联。
研究设计和方法
参与两项研究臂（强化生活方式[ILI]、糖尿病支持和教育[DSE]）的 5145 名参与者（年龄[平均值±标准差]58.7±6.8 岁；BMI35.8±5.8kg/m²）完成贝克抑郁量表（BDI），报告 ADM 使用情况，并在基线和每年进行 4 年的 CVD 风险因素评估。风险因素阳性状态定义为当前吸烟、肥胖、HbA1c＞7.0%或胰岛素使用，以及血压或胆固醇未达到专家共识小组推荐的水平或药物推荐的水平。广义估计方程评估研究臂内升高的 BDI 评分（≥11）或 ADM 使用与随后一年 CVD 风险状况之间的关系，控制了人口统计学变量、CVD 病史、糖尿病持续时间和先前的 CVD 风险状况。
结果
前一年升高的 BDI 与 DSE 臂的随后 CVD 风险因素阳性状态相关（A1C[比值比 1.30（95%CI1.09-1.56）]；总胆固醇[0.80（0.65-1.00）]；即，对高总胆固醇有保护作用）和 ILI 臂（HDL[1.40（1.12-1.75）]，甘油三酯[1.28（1.00-1.64）]）。前一年 ADM 使用预测 DSE 臂的随后升高的 CVD 风险状态（HDL[1.24（1.03-1.50）]，总胆固醇[1.28（1.05-1.57）]，当前吸烟[1.73（1.04-2.88）]）和 ILI 臂（A1C[1.25（1.08-1.46）]，HDL[1.32（1.11-1.58）]，甘油三酯[1.75（1.43-2.14）]，收缩压[1.39（1.11-1.74）]，肥胖[1.46（1.22-2.18）]）。
结论
可能需要对患有抑郁症状或接受 ADM 治疗的糖尿病患者进行更积极的 CVD 风险监测。
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