Ivanovs Rolands, Kivite Anda, Ziedonis Douglas, Mintale Iveta, Vrublevska Jelena, Rancans Elmars
Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia.
Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia.
Front Psychiatry. 2018 Jun 26;9:276. doi: 10.3389/fpsyt.2018.00276. eCollection 2018.
Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of cardiovascular (CV) diseases (CVD). The Systematic Coronary Risk Evaluation (SCORE) function measures the 10-year risk of a fatal CVD and is a crucial tool for guiding CV patient management. This study is the first in Latvia to investigate the association of depression and anxiety with the 10-year CV mortality risk in a primary care population. This cross-sectional study was conducted at 24 primary care facilities. During a 1-week period in 2015, all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by sociodemographic questionnaire and physical measurements. The diagnostic Mini International Neuropsychiatric Interview (M.I.N.I.) was administered by telephone in the period of 2 weeks after the first contact at the primary care facility. A hierarchical multivariate analysis was performed. The study population consisted of 1,569 subjects. Depressive symptoms (PHQ-9 ≥10) were associated with a 1.57 (95% confidence interval (CI): 1.06-2.33) times higher odds of a very high CV mortality risk (SCORE ≥10%), but current anxiety disorder (M.I.N.I.) reduced the CV mortality risk with an odds ratio of 0.58 (95% CI: 0.38-0.90). Our findings suggest that individuals with SCORE ≥10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD. Anxiety could possibly have a protective influence on CV prognosis.
抑郁症和焦虑症已被公认为心血管（CV）疾病（CVD）发生和预后的独立危险因素。系统性冠状动脉风险评估（SCORE）功能可测量致命性CVD的10年风险，是指导心血管疾病患者管理的关键工具。本研究是拉脱维亚首次针对初级保健人群中抑郁症和焦虑症与10年心血管疾病死亡风险之间的关联进行的调查。这项横断面研究在24个初级保健机构开展。在2015年的1周时间里，所有连续就诊的成年患者被邀请完成一份包含9个条目的患者健康问卷（PHQ-9）和一份包含7个条目的广泛性焦虑障碍量表（GAD-7），随后进行社会人口学问卷调查和身体测量。在与初级保健机构首次接触后的2周内，通过电话进行诊断性迷你国际神经精神访谈（M.I.N.I.）。进行了分层多变量分析。研究人群包括1569名受试者。抑郁症状（PHQ-9≥10）与极高心血管疾病死亡风险（SCORE≥10%）的几率高1.57倍（95%置信区间（CI）：1.06 - 2.33）相关，但当前焦虑症（M.I.N.I.）使心血管疾病死亡风险降低，优势比为0.58（95%CI：0.38 - 0.90）。我们的研究结果表明，对于SCORE≥10%的个体，应进行抑郁症筛查和治疗，以潜在地延缓心血管疾病的发展并改善其预后。焦虑可能对心血管疾病预后具有保护作用。
