Department of Epidemiology and Public Health,University College London,London,UK.
Division of Psychiatry,University College London,London,UK.
Psychol Med. 2019 Jul;49(9):1521-1531. doi: 10.1017/S003329171800209X. Epub 2018 Sep 17.
Depressive symptoms and inflammation are risk factors for cardiovascular disease (CVD) and mortality. We investigated the combined association of these factors with the prediction of CVD and all-cause mortality in a representative cohort of older men and women.
We measured C-reactive protein (CRP) and depressive symptoms in 5328 men and women aged 52-89 years in the English Longitudinal Study of Ageing. Depressive symptoms were measured using the eight-item Centre for Epidemiological Studies Depression Scale. CRP was analysed from peripheral blood. Mortality was ascertained from national registers and associations with depressive symptoms and inflammation were estimated using Cox proportional hazard models.
We identified 112 CVD related deaths out of 420 all-cause deaths in men and 109 CVD related deaths out of 334 all-cause deaths in women over a mean follow-up of 7.7 years. Men with both depressive symptoms and high CRP (3-20 mg/L) had an increased risk of CVD mortality (hazard ratio; 95% confidence interval: 3.89; 2.04-7.44) and all-cause mortality (2.40; 1.65-3.48) after adjusting for age, socioeconomic variables and health behaviours. This considerably exceeds the risks associated with high CRP alone (CVD 2.43; 1.59-3.71, all-cause 1.49; 1.20-1.84). There was no significant increase in mortality risk associated with depressive symptoms alone in men. In women, neither depressive symptoms or inflammation alone or the combination of both significantly predicted CVD or all-cause mortality.
The combination of depressive symptoms and increased inflammation confers a considerable increase in CVD mortality risk for men. These effects appear to be independent, suggesting an additive role.
抑郁症状和炎症是心血管疾病（CVD）和死亡的危险因素。我们研究了这些因素的综合关联，以预测代表性的老年男性和女性队列中的 CVD 和全因死亡率。
我们在英国老龄化纵向研究中测量了 5328 名 52-89 岁的男性和女性的 C 反应蛋白（CRP）和抑郁症状。抑郁症状使用八项流行病学研究抑郁量表进行测量。CRP 从外周血中分析。死亡率从国家登记册中确定，使用 Cox 比例风险模型估计抑郁症状和炎症之间的关联。
在平均 7.7 年的随访中，我们在男性中发现了 112 例与 CVD 相关的死亡（420 例全因死亡）和 109 例与 CVD 相关的死亡（334 例全因死亡），在女性中分别为 109 例和 109 例。在调整年龄、社会经济变量和健康行为后，同时患有抑郁症状和高 CRP（3-20mg/L）的男性患 CVD 死亡率（危险比；95%置信区间：3.89；2.04-7.44）和全因死亡率（2.40；1.65-3.48）的风险增加。这大大超过了仅高 CRP 相关的风险（CVD 2.43；1.59-3.71，全因 1.49；1.20-1.84）。在男性中，单独出现抑郁症状并不会显著增加死亡风险。在女性中，抑郁症状或炎症单独或两者的组合均不能显著预测 CVD 或全因死亡率。
抑郁症状和炎症增加的组合使男性 CVD 死亡率的风险显著增加。这些影响似乎是独立的，提示存在相加作用。
