Song Eun Kyeung, Wu Jia-Rong, Moser Debra K, Kang Seok-Min, Lennie Terry A
1 Department of Nursing, University of Ulsan, Korea.
2 School of Nursing, University of North Carolina at Chapel Hill, USA.
Eur J Cardiovasc Nurs. 2018 Mar;17(3):207-216. doi: 10.1177/1474515117727741. Epub 2017 Aug 22.
Depressive symptoms and vitamin D deficiency predict cardiac events in heart failure patients, but whether vitamin D supplements are associated with depressive symptoms and cardiac events in heart failure patients remains unknown.
The purpose of this study was to compare the association of vitamin D supplement use with depressive symptoms and cardiac events in heart failure patients with mild or moderate to severe depressive symptoms.
A total of 177 heart failure patients with depressive symptoms (Patient Health Questionnaire-9 score ≥5) completed a three-day food diary to determine dietary vitamin D deficiency. Patients were split into four groups by dietary vitamin D adequacy versus deficiency and vitamin D supplement use versus non-use. The Patient Health Questionnaire-9 was used to reassess depressive symptoms at six months. Data on cardiac events for up to one year and vitamin D supplement use were obtained from patient interview and medical record review. Hierarchical linear and Cox regressions were used for data analysis.
Sixty-six patients (37.3%) had dietary vitamin D deficiency and 80 (45.2%) used vitamin D supplements. In patients with moderate to severe depressive symptoms, the group with dietary vitamin D deficiency and no supplements had the highest Patient Health Questionnaire-9 score at six months (β=0.542, p<0.001) and shortest cardiac event-free survival ( p<0.001) among the four groups, the group with dietary vitamin D deficiency and no supplements didn't have the highest Patient Health Questionnaire-9 score at six months and shortest cardiac event-free survival in patients with mild depressive symptoms.
Vitamin D supplements predicted lower depressive symptoms and reduced cardiac events for patients with moderate to severe depressive symptoms. Vitamin D deficiency was associated with higher risk of shorter cardiac event-free survival in heart failure patients regardless of vitamin D supplementation.
抑郁症状和维生素D缺乏可预测心力衰竭患者的心脏事件，但维生素D补充剂与心力衰竭患者的抑郁症状和心脏事件之间是否存在关联尚不清楚。
本研究旨在比较维生素D补充剂的使用与轻度或中度至重度抑郁症状的心力衰竭患者的抑郁症状和心脏事件之间的关联。
共有177名有抑郁症状的心力衰竭患者（患者健康问卷-9评分≥5）完成了一份为期三天的食物日记，以确定饮食中维生素D缺乏情况。根据饮食中维生素D充足与否以及是否使用维生素D补充剂，将患者分为四组。在六个月时，使用患者健康问卷-9重新评估抑郁症状。通过患者访谈和病历审查获得长达一年的心脏事件数据和维生素D补充剂使用情况。采用分层线性回归和Cox回归进行数据分析。
66名患者（37.3%）存在饮食中维生素D缺乏，80名（45.2%）使用了维生素D补充剂。在中度至重度抑郁症状的患者中，饮食中维生素D缺乏且未补充的组在六个月时患者健康问卷-9评分最高（β=0.542，p<0.001），在四组中心脏事件无生存时间最短（p<0.001）；在轻度抑郁症状的患者中，饮食中维生素D缺乏且未补充的组在六个月时患者健康问卷-9评分不是最高，心脏事件无生存时间也不是最短。
对于中度至重度抑郁症状的患者，维生素D补充剂可预测抑郁症状减轻和心脏事件减少。无论是否补充维生素D，维生素D缺乏与心力衰竭患者心脏事件无生存时间缩短的较高风险相关。
