Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Depress Anxiety. 2018 Jan;35(1):18-31. doi: 10.1002/da.22689. Epub 2017 Nov 24.
Depression after a cardiovascular disease event (post-CVD) is associated with increased mortality. However, little is known about how pre-existing depression affects survival after CVD incidence.
To evaluate whether depressive symptoms preceding first incident CVD (pre-CVD) affects survival.
From the Rotterdam Study, 6,932 persons aged 55+ and free of dementia and CVD completed the Center for Epidemiological Studies Depression (CES-D) scale every 4 to 5 years from 1993. CES-D subdomains were positive affect, negative affect, somatic symptoms, and interpersonal affect. Persons were followed for mortality and CVD.
During 15-year follow-up, 22% of participants suffered their first incident CVD. Pre-CVD depressive symptoms was not associated with mortality after adjustment for smoking status and physical function (HR per 10-point score: 1.05, 95%CI: 0.99-1.10). After first incident CVD, depressive symptoms increased. Higher post-CVD depressive symptoms was associated with increased mortality (HR: 1.13, 95%CI: 1.06, 1.22). The relation between post-CVD depressive symptoms and mortality was no longer statistically significant after adjustment for pre-CVD depressive symptoms. Pre-CVD and post-CVD measures of somatic symptoms and positive affect were associated with mortality.
During 15 years follow-up in community-dwelling older adults, the relation between higher depressive symptoms measured before first incident CVD and mortality was not independent of health status. Whereas, higher depressive symptoms measured after CVD was associated with increased mortality, was not independent of pre-CVD depressive symptoms. Given the associations observed between positive affect and mortality, positive affect may be the reason we observed a relation between depressive symptoms and mortality.
心血管疾病事件（post-CVD）后抑郁与死亡率增加有关。然而，对于预先存在的抑郁如何影响 CVD 发病后的生存情况知之甚少。
评估 CVD 首次发病前（pre-CVD）的抑郁症状是否会影响生存。
来自鹿特丹研究，6932 名年龄在 55 岁及以上且无痴呆和 CVD 的人群在 1993 年开始，每 4 至 5 年接受一次中心流行病学研究抑郁量表（CES-D）评估。CES-D 亚量表包括积极情绪、消极情绪、躯体症状和人际影响。研究人员对这些人进行了死亡率和 CVD 的随访。
在 15 年的随访期间，22%的参与者首次发生 CVD。在调整吸烟状况和身体功能后，pre-CVD 抑郁症状与死亡率无关（每 10 分评分的 HR：1.05，95%CI：0.99-1.10）。在首次发生 CVD 后，抑郁症状加重。较高的 post-CVD 抑郁症状与死亡率增加相关（HR：1.13，95%CI：1.06，1.22）。在调整 pre-CVD 抑郁症状后，post-CVD 抑郁症状与死亡率之间的关系不再具有统计学意义。pre-CVD 和 post-CVD 的躯体症状和积极情绪测量值与死亡率相关。
在社区居住的老年人群中，在首次发生 CVD 之前测量的较高抑郁症状与死亡率之间的关系并不独立于健康状况。然而，在 CVD 后测量的较高抑郁症状与死亡率增加相关，且与 pre-CVD 抑郁症状无关。鉴于积极情绪与死亡率之间的关联，积极情绪可能是我们观察到抑郁症状与死亡率之间存在关联的原因。
