1 University of Missouri - Kansas City, Kansas City, MO, USA.
2 Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
Vasc Med. 2018 Oct;23(5):454-460. doi: 10.1177/1358863X18770275. Epub 2018 May 25.
The association between depression and peripheral artery disease (PAD) outcomes remains widely understudied. In patients with PAD undergoing a peripheral vascular intervention (PVI) who have a recent diagnosis of depression, it is unknown what their long-term outcomes are and what factors may mediate an adverse risk. We therefore studied 797 consecutive patients undergoing PVI across 33 Veterans Affairs (VA) centers. Depression and outcomes were documented from patients' medical records. Outcomes included: (1) all-cause death; (2) non-fatal cardiovascular events (myocardial infarction, stroke); and (3) PAD-related events (including repeat PVI or amputation). Cox proportional hazards frailty models were constructed, adjusting for age. Additional covariates were selected if they resulted in at least 5% change in the age-adjusted hazard ratio (HR) for depression on outcomes. Overall, 265 (33%) patients had a diagnosis of depression. After a median follow-up of 955 days (range 1-6.25 years), 52 (6.5%) patients died, 30 (3.8%) experienced non-fatal cardiovascular events, and 176 (22.1%) had PAD-related events. Compared to patients without depression, depressed patients had higher rates of non-fatal cardiovascular events (6.4% vs 2.4%, p-value 0.0055). No differences for the other outcomes were noted. Higher risk for non-fatal cardiovascular events persisted after adjustment for age (HR 1.6, 95% CI 1.05-2.47). The only additional covariate that met our selection criteria was hypertension. After adjusting for hypertension, the association between depression and non-fatal cardiovascular outcomes attenuated (HR 1.53, 95% CI 0.99-2.35). In conclusion, a diagnosis of depression in veterans undergoing PVI was associated with increased risk of non-fatal cardiovascular events, mediated by age and hypertension.
抑郁与外周动脉疾病（PAD）结局之间的关联仍未得到广泛研究。在接受外周血管介入治疗（PVI）的 PAD 患者中，如果最近被诊断为抑郁，那么他们的长期结局是什么，以及哪些因素可能会导致不良风险，这些都是未知的。因此，我们研究了在 33 个退伍军人事务部（VA）中心接受 PVI 的 797 例连续患者。从患者的病历中记录了抑郁和结局。结局包括：（1）全因死亡；（2）非致命性心血管事件（心肌梗死、中风）；（3）PAD 相关事件（包括重复 PVI 或截肢）。使用 Cox 比例风险脆弱性模型进行构建，根据年龄进行调整。如果调整后的年龄对抑郁与结局的风险比（HR）的变化至少为 5%，则选择其他协变量。总体而言，265 例（33%）患者被诊断为抑郁。中位随访 955 天（范围 1-6.25 年）后，52 例（6.5%）患者死亡，30 例（3.8%）发生非致命性心血管事件，176 例（22.1%）发生 PAD 相关事件。与无抑郁的患者相比，抑郁患者发生非致命性心血管事件的比率更高（6.4%比 2.4%，p 值<0.0055）。其他结局没有差异。调整年龄后，非致命性心血管事件的风险仍然较高（HR 1.6，95%CI 1.05-2.47）。唯一符合我们选择标准的附加协变量是高血压。调整高血压后，抑郁与非致命性心血管结局之间的关联减弱（HR 1.53，95%CI 0.99-2.35）。总之，在接受 PVI 的退伍军人中，抑郁的诊断与非致命性心血管事件的风险增加相关，这与年龄和高血压有关。
