May Heidi T, Bair Tami L, Reiss-Brennan Brenda, Knight Stacey, Anderson Jeffrey L, Horne Benjamin D, Brunisholz Kimberly D, Muhlestein Joseph B
a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.
b Department of Medicine , University of Utah , Salt Lake City , UT , USA.
Psychol Health Med. 2017 Sep;22(8):919-931. doi: 10.1080/13548506.2017.1281975. Epub 2017 Jan 22.
Depression has been reported to be associated with a greater risk of death and cardiovascular disease (CVD); however, the impact of antidepressants (ADM) on CVD risk remains controversial. Statin use is known to decrease CVD risk. Whether the use of these medications together affects CVD risk has not been studied. Patients (N = 26,828) completing the patient health questionnaire (PHQ-9), ≥40 years of age, without prior CVD, and no prior ADM use were studied. Depressive severity was categorized as none-mild (PHQ-9 score ≤14, n = 21,517) and moderate-severe (PHQ-9 score ≥15, n = 5311). Cox hazard regression was used to evaluate the association of no ADM/no statin use (n = 23,104 [86.1%]), ADM/no statin use (n = 877 [3.3%]), no ADM/statin use (n = 2627 [9.8%]), and ADM/statin use (n = 220 [.8%]) with major adverse cardiovascular events (MACE: death, CAD, stroke). Patients averaged 56 ± 12 years; 61% female. There were 1182 (4.4%) 3 year MACE events. The association of ADM and statin use with MACE varied by depressive symptom severity, with statin therapy associated with a decreased risk in the none-mild group (HR = .78, p = .007) and ADM in the moderate-high group (HR = 0.58, p = 0.02). Concomitant use of ADMs and statins did not appear to provide additive benefit.
据报道，抑郁症与更高的死亡风险和心血管疾病（CVD）相关；然而，抗抑郁药（ADM）对心血管疾病风险的影响仍存在争议。已知使用他汀类药物可降低心血管疾病风险。尚未研究同时使用这些药物是否会影响心血管疾病风险。对完成患者健康问卷（PHQ-9）、年龄≥40岁、无既往心血管疾病且无既往抗抑郁药使用史的患者（N = 26,828）进行了研究。抑郁严重程度分为无-轻度（PHQ-9评分≤14，n = 21,517）和中度-重度（PHQ-9评分≥15，n = 5311）。采用Cox风险回归评估未使用抗抑郁药/未使用他汀类药物（n = 23,104 [86.1%]）、使用抗抑郁药/未使用他汀类药物（n = 877 [3.3%]）、未使用抗抑郁药/使用他汀类药物（n = 2627 [9.8%]）以及使用抗抑郁药/使用他汀类药物（n = 220 [.8%]）与主要不良心血管事件（MACE：死亡、冠心病、中风）之间的关联。患者平均年龄为56±12岁；61%为女性。有1182例（4.4%）发生3年MACE事件。抗抑郁药和他汀类药物的使用与MACE的关联因抑郁症状严重程度而异，他汀类药物治疗在无-轻度组中与风险降低相关（HR = .78，p = .007），而抗抑郁药在中度-高度组中与风险降低相关（HR = 0.58，p = 0.02）。同时使用抗抑郁药和他汀类药物似乎并未提供额外益处。
