Pizzi Carmine, Santarella Luigi, Manfrini Olivia, Chiavaroli Martina, Agushi Erjon, Cordioli Elvira, Costa Grazia Maria, Bugiardini Raffaele
Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università Alma Mater Studiorum, Bologna, Italy.
G Ital Cardiol (Rome). 2013 Jul-Aug;14(7-8):526-37. doi: 10.1714/1308.14461.
Patients with acute or chronic ischemic heart disease have a high incidence of depression, and a variable proportion of patients (ranging from 14% to 47%) suffer from major or subclinical depression. In addition, chronic depression has been shown to be associated with the development or progression of coronary atherosclerosis. Besides a poor quality of life, depressive symptoms in patients with ischemic heart disease result in a poor prognosis, as cardiovascular event rates are 2-2.5 times higher than in their counterparts without depressive symptoms. A variety of pathogenetic mechanisms may play a role, including pathophysiological (dysfunction of the autonomic nervous system or hypothalamic-pituitary-adrenal axis, platelet hyperaggregability, inflammation, endothelial dysfunction and genetic predisposition) and behavioral mechanisms (inadequate therapy adherence, obesity, smoking, sedentary lifestyle). However, in patients with ischemic heart disease, depression often goes undiagnosed or untreated. Several screening procedures including questionnaires for patients with heart disease, along with the help of a psychiatrist, may facilitate not only the diagnosis of depressive symptoms but also the pharmacological and/or physiotherapeutic management. The use of tricyclic antidepressant agents should be avoided in patients with heart disease, whereas selective serotonin reuptake inhibitors have been shown to be safe in this patient population. However, no evidence is available to support that use of these drugs is associated with a reduced risk of cardiovascular events at follow-up. Psychotherapy proved to be effective in reducing depressive symptoms but ineffective in improving prognosis. In this review, epidemiology and pathophysiology of depression in patients with ischemic heart disease are described, with a focus on stratification of depressive symptoms and potential therapeutic strategies.
急性或慢性缺血性心脏病患者抑郁症的发病率很高，且有一定比例的患者（14%至47%不等）患有重度或亚临床抑郁症。此外，慢性抑郁症已被证明与冠状动脉粥样硬化的发生或进展有关。除了生活质量差之外，缺血性心脏病患者的抑郁症状还会导致预后不良，因为心血管事件发生率比没有抑郁症状的患者高出2至2.5倍。多种致病机制可能起作用，包括病理生理机制（自主神经系统或下丘脑 - 垂体 - 肾上腺轴功能障碍、血小板高聚集性、炎症、内皮功能障碍和遗传易感性）和行为机制（治疗依从性不足、肥胖、吸烟、久坐不动的生活方式）。然而，在缺血性心脏病患者中，抑郁症往往未被诊断或治疗。包括针对心脏病患者的问卷在内的几种筛查程序，在精神科医生的帮助下，不仅有助于诊断抑郁症状，还能促进药物和/或物理治疗管理。心脏病患者应避免使用三环类抗抑郁药，而选择性5-羟色胺再摄取抑制剂在这类患者中已被证明是安全的。然而，没有证据支持使用这些药物与随访时心血管事件风险降低有关。心理治疗被证明对减轻抑郁症状有效，但对改善预后无效。在这篇综述中，描述了缺血性心脏病患者抑郁症的流行病学和病理生理学，重点是抑郁症状的分层和潜在的治疗策略。
