Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford St, LD 100E, Indianapolis, IN 46202.
Psychosom Med. 2014 Jan;76(1):38-43. doi: 10.1097/PSY.0000000000000023. Epub 2013 Dec 23.
Because it is not known whether particular clusters of depressive symptoms are associated with a greater risk of adverse cardiac outcomes, we compared the utility of four clusters in predicting incident coronary artery disease (CAD) events during a 15-year period in a large cohort of primary care patients 60 years and older.
Participants were 2537 primary care patients 60 years or older who were screened for depression between 1991 and 1993 and had no existing CAD diagnosis. Depressive symptoms cluster scores (depressed affect, somatic symptoms, interpersonal distress, and positive affect) were computed from responses on the Center for Epidemiologic Studies Depression Scale administered at baseline. CAD events, defined as the occurrence of a nonfatal acute myocardial infarction or CAD death during the follow-up period, were identified using electronic medical record and National Death Index data.
There were 678 CAD events. In separate fully adjusted Cox proportional hazard models (controlling for demographics and cardiovascular risk factors), the depressed affect (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.04-1.20), somatic (HR = 1.17, 95% CI = 1.08-1.26), and positive affect (HR = 0.88, 95% CI = 0.82-0.95) clusters each predicted CAD events. When the depressive symptom clusters were entered simultaneously into the fully adjusted model, however, only the somatic cluster remained predictive of CAD events (HR = 1.13, 95% CI = 1.03-1.23).
Our findings suggest that the longitudinal relationship between overall depressive symptom severity and incident CAD events may be driven primarily by the somatic cluster.
由于目前尚不清楚特定的抑郁症状群是否与不良心脏结局风险增加相关，我们比较了在 15 年期间，在一个大型初级保健患者队列中（年龄在 60 岁及以上），四个聚类在预测新发冠状动脉疾病（CAD）事件中的作用。
参与者为 2537 名年龄在 60 岁及以上的初级保健患者，他们在 1991 年至 1993 年期间接受了抑郁症筛查，但没有现有的 CAD 诊断。使用基线时的流行病学研究抑郁量表（CES-D）的回答计算抑郁症状聚类评分（抑郁情绪、躯体症状、人际困扰和积极情绪）。CAD 事件定义为随访期间发生非致命性急性心肌梗死或 CAD 死亡。通过电子病历和国家死亡索引数据识别 CAD 事件。
共发生 678 例 CAD 事件。在单独的完全调整后的 Cox 比例风险模型（控制人口统计学和心血管危险因素）中，抑郁情绪（风险比[HR] = 1.11，95%置信区间[CI] = 1.04-1.20）、躯体（HR = 1.17，95% CI = 1.08-1.26）和积极情绪（HR = 0.88，95% CI = 0.82-0.95）聚类均预测 CAD 事件。然而，当将抑郁症状聚类同时纳入完全调整后的模型中时，只有躯体聚类仍然预测 CAD 事件（HR = 1.13，95% CI = 1.03-1.23）。
我们的发现表明，整体抑郁症状严重程度与新发 CAD 事件之间的纵向关系可能主要由躯体聚类驱动。
