Jani Bhautesh Dinesh, Cavanagh Jonathan, Barry Sarah J E, Der Geoff, Sattar Naveed, Mair Frances S
Professor of Primary Care Research, General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G112 9LX, UK.
BMC Cardiovasc Disord. 2014 Oct 28;14:139. doi: 10.1186/1471-2261-14-139.
Depression is common in patients with cardiometabolic diseases but little is known about the relationship, if any, between cardiovascular risk factor values and depressive symptoms in patients with these conditions. The objective of this paper is to study the association between cardiovascular risk factors and concurrent depressive symptoms in patients with three common cardiometabolic conditions: coronary heart disease (CHD), stroke and diabetes.
We retrospectively reviewed primary care data for N = 35537 with 1 of the above 3 conditions who underwent depression screening using the depressive subscale of hospital anxiety and depression score (HADS-D). We reviewed 4 cardiometabolic risk factors (Systolic Blood Pressure [SBP], Diastolic Blood Pressure [DBP], BMI and total cholesterol) recorded concurrently in all patients and HbA1c in patients with diabetes (n = 18453). We analysed the association between individual risk factor value and a positive HADS-D screening result (>7) using logistic regression.
SBP and BMI were noted to have a non-linear "J-shaped" relationship with the probability of having a positive HADS-D and observed nadirs (levels with the lowest probability) of 148 mm Hg and 30.70 kg/m2, respectively. Total cholesterol and DBP found to have a weaker curvilinear association with concurrent depression symptoms and nadirs of 3.60 mmol/l and 74 mmHg. Among patients with Diabetes, HbA1c was also found to have a "J-shaped" relationship with probability of having a positive HADS-D with an observed nadir of 7.06% DCCT. The above relationships remain significant after adjusting for age, sex, socio-economic status and number of co-morbid conditions.
In patients with cardiometabolic disease, cardiovascular risk factor values at both extremes were associated with higher positive depression screening after adjusting for confounders. These findings have potentially important implications for clinical practice in relation to both risk stratification for depression and approaches to secondary prevention in individuals with cardiometabolic disease and merit further investigation to determine the nature and direction of the observed association.Please see related article: http://www.biomedcentral.com/1741-7015/12/199.
抑郁症在心血管代谢疾病患者中很常见，但对于这些疾病患者的心血管危险因素值与抑郁症状之间的关系（如果存在的话）却知之甚少。本文的目的是研究三种常见心血管代谢疾病（冠心病、中风和糖尿病）患者的心血管危险因素与并发抑郁症状之间的关联。
我们回顾性分析了N = 35537例患有上述三种疾病之一且使用医院焦虑抑郁量表（HADS-D）的抑郁分量表进行抑郁筛查的初级保健数据。我们回顾了所有患者同时记录的4种心血管代谢危险因素（收缩压[SBP]、舒张压[DBP]、体重指数和总胆固醇）以及糖尿病患者（n = 18453）的糖化血红蛋白（HbA1c）。我们使用逻辑回归分析了个体危险因素值与HADS-D筛查结果阳性（>7）之间的关联。
SBP和体重指数与HADS-D筛查结果阳性的概率呈非线性“J形”关系，观察到的最低点（概率最低的水平）分别为148 mmHg和30.70 kg/m²。总胆固醇和DBP与并发抑郁症状的曲线关联较弱，最低点分别为3.60 mmol/l和74 mmHg。在糖尿病患者中，HbA1c与HADS-D筛查结果阳性的概率也呈“J形”关系，观察到的最低点为7.06% DCCT。在调整年龄、性别、社会经济地位和共病数量后，上述关系仍然显著。
在心血管代谢疾病患者中，调整混杂因素后，两端的心血管危险因素值与更高的抑郁筛查阳性率相关。这些发现对于抑郁症的风险分层以及心血管代谢疾病患者的二级预防方法的临床实践可能具有重要意义，值得进一步研究以确定观察到的关联的性质和方向。请参阅相关文章：http://www.biomedcentral.com/1741-7015/12/199。
