抑郁、焦虑、共病及抗抑郁药对静息心率及其变异性的影响：ELSA-Brasil 队列研究基线分析
Effects of depression, anxiety, comorbidity, and antidepressants on resting-state heart rate and its variability: an ELSA-Brasil cohort baseline study.
机构信息
From University Hospital and the Faculty of Medicine, University of São Paulo, São Paulo, Brazil; the School of Psychology and Discipline of Psychiatry, University of Sydney, Sydney, Australia; the Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; the Collegiate of Biological Sciences, Federal University of Vale do São Francisco, Petrolina, Pernambuco, Brazil; Campus Centro Oeste Dona Lindu, Federal University of São João Del-Rei, Brazil; the Laboratory of Genetics and Molecular Cardiology, Heart Institute/InCor, University of São Paulo Medical School, São Paulo; Hospital das Clínicas and Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; the Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil; and the Department of Psychology, Ohio State University, Columbus.
出版信息
Am J Psychiatry. 2014 Dec 1;171(12):1328-34. doi: 10.1176/appi.ajp.2014.13121605. Epub 2014 Oct 31.
OBJECTIVE
Increases in resting-state heart rate and decreases in its variability are associated with substantial morbidity and mortality, yet contradictory findings have been reported for the effects of the mood and anxiety disorders and of antidepressants. The authors investigated heart rate and heart rate variability in a large cohort from Brazil, using propensity score weighting, a relatively novel method, to control for numerous potential confounders.
METHOD
A total of 15,105 participants were recruited in the Brazilian Longitudinal Study of Adult Health. Mood and anxiety disorders were ascertained using the Portuguese version of the Clinical Interview Schedule-Revised. Heart rate and its variability were extracted from 10-minute resting-state electrocardiograms. Regressions weighted by propensity scores were carried out to compare participants with and without depressive or anxiety disorders, as well as users and non-users of antidepressants, on heart rate and heart rate variability.
RESULTS
Use of antidepressants was associated with increases in heart rate and decreases in its variability. Effects were most pronounced for the tricyclic antidepressants (Cohen's d, 0.72-0.81), followed by serotonin and norepinephrine reuptake inhibitors (Cohen's d, 0.42-0.95) and other antidepressants (Cohen's d, 0.37-0.40), relative to participants not on antidepressants. Only participants with generalized anxiety disorder showed robust, though small, increases in heart rate and decreases in its variability after propensity score weighting.
CONCLUSIONS
The findings may, in part, underpin epidemiological findings of increased risk for cardiovascular morbidity and mortality. Many factors that have an adverse impact on cardiac activity were controlled for in this study, highlighting the importance of cardiovascular risk reduction strategies. Further study is needed to examine whether, how, and when such effects contribute to morbidity and mortality.
目的
静息心率增加和变异性降低与大量发病率和死亡率相关，然而心境和焦虑障碍以及抗抑郁药的影响却有相互矛盾的发现。作者使用倾向评分加权这一相对较新的方法，在一个来自巴西的大型队列中研究了心率和心率变异性，以控制许多潜在的混杂因素。
方法
共有 15105 名参与者参加了巴西成人健康纵向研究。使用葡萄牙语版临床访谈时间表修订版确定心境和焦虑障碍。从 10 分钟静息状态心电图中提取心率及其变异性。使用倾向评分进行加权回归，以比较有和没有抑郁或焦虑障碍的参与者，以及使用和不使用抗抑郁药的参与者的心率和心率变异性。
结果
使用抗抑郁药与心率增加和变异性降低有关。三环类抗抑郁药的效果最为显著（Cohen's d，0.72-0.81），其次是 5-羟色胺和去甲肾上腺素再摄取抑制剂（Cohen's d，0.42-0.95）和其他抗抑郁药（Cohen's d，0.37-0.40），与未使用抗抑郁药的参与者相比。只有广泛性焦虑障碍患者在进行倾向评分加权后，心率显著增加，心率变异性降低，但幅度较小。
结论
这些发现可能部分解释了心血管发病率和死亡率增加的流行病学发现。本研究控制了许多对心脏活动有不利影响的因素，突出了降低心血管风险策略的重要性。需要进一步研究以检查这些影响是否、如何以及何时导致发病率和死亡率。
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