Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
University of Quebec in Montreal and Research Centre, Hôpital du Sacré-Coeur de Montréal, Québec, Canada.
Am J Med. 2014 Jan;127(1):87-93.e1-2. doi: 10.1016/j.amjmed.2013.09.026. Epub 2013 Oct 16.
The association between depression and cardiovascular disease severity in younger patients has not been assessed, and sex differences are unknown. We assessed whether major depression and depressive symptoms were associated with worse cardiovascular disease severity in patients with premature acute coronary syndrome, and we assessed sex differences in these relationships.
We enrolled 1023 patients (aged ≤ 55 years) hospitalized with acute coronary syndrome from 26 centers in Canada, the United States, and Switzerland, through the GENdEr and Sex determInantS of cardiovascular disease: From bench to beyond-Premature Acute Coronary Syndrome study. Left ventricular ejection fraction, Killip class, cardiac troponin I, and Global Registry of Acute Coronary Events score data were collected through chart review.
The sample comprised 248 patients with major depression and 302 women. In univariate analyses, major depression was associated with a lower likelihood of having an abnormal left ventricular ejection fraction (odds ratio, 0.70; 95% confidence interval, 0.51-0.97; P = .03) and lower troponin I levels (estimate, -4.04; 95% confidence interval, -8.01 to -0.06; P = .05). After adjustment for sociodemographic and clinical characteristics, neither major depression nor depressive symptoms were associated with disease severity indices, and there were no sex differences.
The increased risk of adverse events in depressed patients with premature acute coronary syndrome is not explained by disease severity.
尚未评估年轻患者中抑郁与心血管疾病严重程度之间的关系，且性别差异也不明确。我们评估了在患有早发性急性冠状动脉综合征的患者中，重度抑郁症和抑郁症状是否与心血管疾病严重程度恶化相关，并评估了这些关系中的性别差异。
我们通过加拿大、美国和瑞士的 26 个中心的 GENdEr 和 Sex determInantS of cardiovascular disease: From bench to beyond-Premature Acute Coronary Syndrome 研究，纳入了 1023 名因急性冠状动脉综合征住院的≤55 岁患者（n=1023）。通过病历回顾收集左心室射血分数、Killip 分级、心脏肌钙蛋白 I 和全球急性冠状动脉事件注册评分数据。
样本包括 248 例重度抑郁症患者和 302 名女性。在单变量分析中，重度抑郁症与左心室射血分数异常的可能性较低相关（比值比，0.70；95%置信区间，0.51-0.97；P=0.03），且心脏肌钙蛋白 I 水平较低（估计值，-4.04；95%置信区间，-8.01 至-0.06；P=0.05）。在校正社会人口学和临床特征后，重度抑郁症和抑郁症状均与疾病严重程度指数无关，且无性别差异。
早发性急性冠状动脉综合征伴抑郁患者发生不良事件的风险增加不能用疾病严重程度来解释。
