Armstrong Nicole M, Meoni Lucy A, Carlson Michelle C, Xue Qian-Li, Bandeen-Roche Karen, Gallo Joseph J, Gross Alden L
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins Center on Aging and Health, Baltimore, MD, USA.
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Affect Disord. 2017 May;214:60-66. doi: 10.1016/j.jad.2017.03.004. Epub 2017 Mar 6.
Modifiable cardiovascular risk factors elevate risk of subsequent depression in older adults, but the effect of their onset before or after age 65 on incident depression is unclear.
Participants were 1190 male medical students without a diagnosis of depression, who matriculated in 1948-1964 and followed through 2011. Cox proportional hazards models were used to assess associations of vascular risk-factor burden, diabetes, hypertension, hyperlipidemia, smoking status, and overweight/obese status with onset of incident depression. Adjustment covariates were race, enrollment wave, baseline age, physical activity, and heavy alcohol use.
The analysis included 44,175 person-years of follow-up. Among participants depression-free until age 65, vascular risk-factor burden after age 65 (Hazard Ratio, [HR]: 2.13, 95% Confidence Interval, [CI]: 1.17, 3.90) was associated with incident depression risk after age 65. The magnitude of vascular risk-factor burden after age 65 on depression risk after age 65 is comparable to the effect of 8.2 additional years of age. Diabetes (HR: 2.79, 95% CI: 1.25, 6.26), hypertension (HR: 2.72, 95% CI: 1.52, 4.88), and hyperlipidemia (HR: 1.88, 95% CI: 1.05, 3.35) before age 65 were associated with incident depression risk after age 65. Men diagnosed with diabetes after age 65 had 2.87 times the risk of incident depression after age 65 (95% CI: 1.24, 6.62).
Our findings are restricted to male former medical students, which may affect study generalizability.
Results support the vascular depression hypothesis. Depression screening in older adults with vascular risk-factor burden may provide an avenue for prevention of late-onset depression.
可改变的心血管危险因素会增加老年人后续患抑郁症的风险，但这些因素在65岁之前或之后出现对新发抑郁症的影响尚不清楚。
参与者为1190名未被诊断出患有抑郁症的男性医学生，他们于1948年至1964年入学，并随访至2011年。采用Cox比例风险模型评估血管危险因素负担、糖尿病、高血压、高脂血症、吸烟状况以及超重/肥胖状况与新发抑郁症发病之间的关联。调整协变量包括种族、入学批次、基线年龄、身体活动和大量饮酒。
分析包括44175人年的随访。在65岁之前无抑郁症的参与者中，65岁之后的血管危险因素负担（风险比，[HR]：2.13，95%置信区间，[CI]：1.17，3.90）与65岁之后的新发抑郁症风险相关。65岁之后血管危险因素负担对65岁之后抑郁症风险的影响程度与额外8.2岁的影响相当。65岁之前的糖尿病（HR：2.79，95%CI：1.25，6.26）、高血压（HR：2.72，95%CI：：1.52，4.88）和高脂血症（HR：1.88，95%CI：1.05，3.35）与65岁之后的新发抑郁症风险相关。65岁之后被诊断出患有糖尿病的男性在65岁之后患新发抑郁症的风险是其他人的2.87倍（95%CI：1.24，6.62）。
我们的研究结果仅限于男性前医学生，这可能会影响研究的普遍性。
结果支持血管性抑郁症假说。对有血管危险因素负担的老年人进行抑郁症筛查可能为预防迟发性抑郁症提供一条途径。
