抑郁增加老年人死亡风险，与血管事件无关：三城市研究。
Depression Increases the Risk of Death Independently From Vascular Events in Elderly Individuals: The Three-City Study.
机构信息
INSERM U970, Paris Cardiovascular Research Center, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
Service de Médecine et Réadaptation, Hôpitaux de Saint-Maurice, Saint-Maurice, France.
出版信息
J Am Geriatr Soc. 2019 Mar;67(3):546-552. doi: 10.1111/jgs.15731. Epub 2019 Jan 17.
BACKGROUND
How much the association between depressive symptoms (DSs) and all-cause mortality depends on cardiovascular disease (CVD) events is poorly known. We aimed to prospectively quantify the association between DSs at repeated study visits and all-cause and cause-specific mortality, and the influence of incident CVD on this association.
METHODS
The Three-City Study has included adults 65 years and older, who were examined at baseline between 1999 and 2001 and after 2, 4, 7, and 10 years of follow-up. At each visit, a score of 16 or greater on the 20-item Center for Epidemiologic Studies Depression Scale defined the presence of DSs. DS status and incident coronary heart disease or stroke events were used as time-dependent variables in a Cox proportional hazard model of mortality.
RESULTS
We studied 7377 participants (63.7% females) aged 73.8 years (SD = 5.4 years) without a history of CVD at baseline examination. DSs were present in 19% to 22% of subjects at each study visit. During a median follow-up of 9.4 years, 650 subjects developed a first CVD, and 1255 had died. After adjustment for baseline sociodemographic variables, vascular risk factors, impairment in daily life activities, and antidepressants, time-dependent DSs were associated with a 28% increased risk of mortality (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.06-1.55), and incident CVD event was associated with a 63% increased risk (HR = 1.63; 95% CI = 1.30-2.04). However, the association between DSs and mortality was not influenced by the occurrence of CVD (HR for DS and CVD interaction = 1.03; 95% CI = 0.66-1.61). A mediation analysis confirmed that incident CVD only explained 6.9% of the excess of mortality associated with DSs.
CONCLUSION
In older participants, the increased risk of all-cause mortality associated with the presence of DSs at baseline and during follow-up is not modified by and is moderately mediated by incident CVD. J Am Geriatr Soc 67:546-552, 2019.
背景
抑郁症状（DSs）与全因死亡率之间的关联在多大程度上取决于心血管疾病（CVD）事件尚不清楚。我们旨在前瞻性地量化在重复研究访视中 DSs 与全因和死因特异性死亡率之间的关联，以及 CVD 事件对这种关联的影响。
方法
三城市研究纳入了年龄在 65 岁及以上的成年人，他们在 1999 年至 2001 年之间进行了基线检查，并在 2、4、7 和 10 年的随访后进行了检查。在每次访视中，20 项流行病学研究中心抑郁量表的得分为 16 分或更高定义为存在 DSs。DSs 状态和新发冠心病或卒中事件被用作死亡率的 Cox 比例风险模型中的时间依赖性变量。
结果
我们研究了 7377 名参与者（63.7%为女性），年龄为 73.8 岁（SD=5.4 岁），基线检查时无 CVD 病史。在每次研究访视中，19%至 22%的受试者存在 DSs。在中位随访 9.4 年期间，650 名受试者发生了首次 CVD，1255 名受试者死亡。调整基线社会人口统计学变量、血管危险因素、日常生活活动受损和抗抑郁药后，时间依赖性 DSs 与死亡率增加 28%相关（风险比[HR]=1.28；95%置信区间[CI]：1.06-1.55），新发 CVD 事件与死亡率增加 63%相关（HR=1.63；95%CI：1.30-2.04）。然而，DSs 与死亡率之间的关联不受 CVD 发生的影响（DSs 和 CVD 事件交互作用的 HR=1.03；95%CI：0.66-1.61）。中介分析证实，新发 CVD 仅解释了与 DSs 相关的死亡率升高的 6.9%。
结论
在老年参与者中，基线和随访期间存在 DSs 与全因死亡率增加相关的风险，不受新发 CVD 的影响，并适度受新发 CVD 的影响。J Am Geriatr Soc 67：546-552，2019。
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