Almas Aysha, Forsell Yvonne, Iqbal Romaina, Janszky Imre, Moller Jette
Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden; Department of Medicine, Aga Khan University, Karachi, Pakistan.
Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
PLoS One. 2015 Oct 15;10(10):e0140742. doi: 10.1371/journal.pone.0140742. eCollection 2015.
Depression is known to be associated with cardiovascular diseases (CVD). This population-based cohort study aimed to determine the association between depression of varying severity and risk for CVD and to study the effect of concomitant anxious distress on this association.
We utilized data from a longitudinal cohort study of mental health, work and relations among adults (20-64 years), with a total of 10,443 individuals. Depression and anxious distress were assessed using psychiatric rating scales and defined according to DSM-5. Outcomes were register-based and self-reported cardiovascular diseases.
Overall increased odds ratios of 1.5 to 2.6 were seen for the different severity levels of depression, with the highest adjusted OR for moderate depression (OR 2.1 (95% CI 1.3, 3.5). Similar odds ratios were seen for sub-groups of CVD: ischemic/hypertensive heart disease and stroke, 2.4 (95% CI 1.4, 3.9) and OR 2.1 (95%CI 1.2, 3.8) respectively. Depression with anxious distress as a specifier of severity showed OR of 2.1 (95% CI 1.5, 2.9) for CVD.
This study found that severity level of depression seems to be of significance for increased risk of CVD among depressed persons, although not in a dose-response manner which might be obscured due to treatment of depression. Further, we found a higher risk of CVD among depressed individuals with symptoms of anxious distress.
已知抑郁症与心血管疾病（CVD）相关。这项基于人群的队列研究旨在确定不同严重程度的抑郁症与心血管疾病风险之间的关联，并研究伴随的焦虑性痛苦对这种关联的影响。
我们利用了一项关于成年人（20 - 64岁）心理健康、工作和人际关系的纵向队列研究的数据，共有10443人。使用精神科评定量表评估抑郁症和焦虑性痛苦，并根据《精神疾病诊断与统计手册》第5版（DSM - 5）进行定义。结局指标为基于登记和自我报告的心血管疾病。
不同严重程度的抑郁症总体优势比增加了1.5至2.6，中度抑郁症的调整后优势比最高（优势比2.1（95%置信区间1.3, 3.5））。心血管疾病亚组（缺血性/高血压性心脏病和中风）的优势比类似，分别为2.4（95%置信区间1.4, 3.9）和优势比2.1（95%置信区间1.2, 3.8）。以焦虑性痛苦作为严重程度指标的抑郁症，心血管疾病的优势比为2.1（95%置信区间1.5, 2.9）。
本研究发现，抑郁症的严重程度似乎对抑郁症患者心血管疾病风险增加具有重要意义，尽管不是以剂量反应方式，这可能因抑郁症的治疗而被掩盖。此外，我们发现有焦虑性痛苦症状的抑郁症患者患心血管疾病的风险更高。
