Center for Clinical and Epidemiologic Research, University Hospital and Faculty of Medicine, University of São Paulo, São Paulo Brazil ; School of Psychology and Discipline of Psychiatry, University of Sydney, Sydney, NSW Australia.
Center for Clinical and Epidemiologic Research, University Hospital and Faculty of Medicine, University of São Paulo, São Paulo Brazil.
Front Psychol. 2015 Feb 25;6:187. doi: 10.3389/fpsyg.2015.00187. eCollection 2015.
Associations between major depressive disorder (MDD) and coronary heart disease (CHD) have been established, and these associations increase risk of future morbidity and mortality. Prior research has been carried out in high-income countries. Here we examine associations between the mood and anxiety disorders, and CHD in a large cohort at baseline from Brazil, a country facing a variety of challenges that may affect these associations.
Participants included 15,105 civil servants aged 35 to 74 at baseline (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CHD (N = 721) included self-reported angina pectoris (n = 305), myocardial infarction (n = 259) and coronary revascularization (n = 239). Hierarchical logistic regression analyses were conducted to estimate odds ratios and confidence intervals.
Major findings indicate that comorbid MDD and anxiety disorders (n = 434) are associated with a threefold increase in CHD, MDD alone (n = 170) with a twofold increase in CHD, while generalized anxiety disorder alone (n = 1,394) and mixed anxiety and depression disorder (n = 1,844) - symptoms present, but diagnostic threshold not reached - are associated with a 1.5-fold increase in CHD, after full adjustment for covariates.
The association with CHD is greatest in those with psychiatric comorbidity, while associations were also observed in MDD and generalized anxiety disorder without comorbidity. While findings are limited by the cross-sectional design of the study, given the known risks associated with comorbidity of the mood and anxiety disorders with CHD, findings reinforce the importance of comprehensive health assessment in Brazil.
重度抑郁症（MDD）和冠心病（CHD）之间存在关联，这些关联增加了未来发病和死亡的风险。先前的研究是在高收入国家进行的。在这里，我们在基线时从巴西的一个大队列中检查了情绪和焦虑障碍与 CHD 之间的关联，巴西面临着各种可能影响这些关联的挑战。
参与者包括基线时（2008-2010 年）年龄在 35 至 74 岁的 15105 名公务员，来自巴西成人健康纵向研究（ELSA-Brasil）。CHD（N=721）包括自述心绞痛（n=305）、心肌梗死（n=259）和冠状动脉血运重建术（n=239）。进行分层逻辑回归分析以估计比值比和置信区间。
主要发现表明，共患 MDD 和焦虑症（n=434）与 CHD 风险增加三倍相关，MDD 单独（n=170）与 CHD 风险增加两倍相关，而广泛性焦虑症单独（n=1394）和混合焦虑和抑郁障碍（n=1844）-存在症状，但未达到诊断阈值-与 CHD 风险增加 1.5 倍相关，调整了所有协变量。
与 CHD 的关联在精神共病患者中最大，而在无共病的 MDD 和广泛性焦虑症中也观察到了关联。鉴于情绪和焦虑障碍与 CHD 相关的已知风险，尽管研究设计存在局限性，但研究结果强调了在巴西进行全面健康评估的重要性。
