长期的抑郁症状和抗抑郁药物使用与 2 型糖尿病减肥临床试验 LOOK AHEAD（糖尿病健康行动）中心血管事件的发生相关。
Long-term Association of Depression Symptoms and Antidepressant Medication Use With Incident Cardiovascular Events in the Look AHEAD (Action for Health in Diabetes) Clinical Trial of Weight Loss in Type 2 Diabetes.
机构信息
The University of Texas Health Science Center at San Antonio, San Antonio, TX
Wake Forest School of Medicine, Winston-Salem, NC.
出版信息
Diabetes Care. 2019 May;42(5):910-918. doi: 10.2337/dc18-0575. Epub 2019 Mar 4.
OBJECTIVE
To examine whether depression symptoms or antidepressant medication (ADM) use predicts the probability of cardiovascular events in overweight/obese individuals with type 2 diabetes.
RESEARCH DESIGN AND METHODS
Preplanned analyses of depression and incident cardiovascular disease (CVD) were performed in the Look AHEAD (Action for Health in Diabetes) weight loss trial after a median follow-up of 9.6 years. Depression symptoms, assessed with the Beck Depression Inventory (BDI), were analyzed both as a continuous and dichotomized variable (BDI score <10 or ≥10). ADM use was coded from participants' prescription medications. Four composite CVD outcomes were defined in the study protocol. Sex-stratified Cox proportional hazards models were adjusted for a range of baseline covariates.
RESULTS
Depression symptoms were only significantly associated with a composite secondary outcome comprising CVD death, nonfatal myocardial infarction, nonfatal stroke, hospitalized angina, congestive heart failure, peripheral vascular disease, coronary artery bypass graft, and carotid endarterectomy. Significant sex interactions were observed for BDI score and BDI score ≥10. BDI score was significantly associated with higher probability of this composite outcome in men but was not associated with the outcome in women. BDI score ≥10 was positively associated with this composite outcome in men but was negatively associated in women. Exploratory analysis identified a significant BDI ≥10 × ADM use interaction for this composite outcome that differed in men versus women. Men with both BDI score ≥10 and ADM use compared with those with neither had 60% higher probability of the outcome, whereas women with both compared with those with neither had 50% lower probability.
CONCLUSIONS
Sex differences in the association of depression symptoms and ADM use with incident CVD warrant further investigation.
目的
研究抑郁症状或抗抑郁药物（ADM）的使用是否可预测 2 型糖尿病超重/肥胖患者发生心血管事件的概率。
研究设计和方法
在 LOOK AHEAD（糖尿病中的健康行动）减肥试验中，对预先计划的抑郁和心血管疾病（CVD）发病分析进行了研究，中位随访时间为 9.6 年。使用贝克抑郁量表（BDI）评估抑郁症状，分别作为连续变量和二分类变量（BDI 评分＜10 或≥10）进行分析。ADM 的使用情况由参与者的处方药物编码。在研究方案中定义了 4 种复合 CVD 结局。性别分层 Cox 比例风险模型调整了一系列基线协变量。
结果
抑郁症状仅与包含 CVD 死亡、非致死性心肌梗死、非致死性卒中等复合次要结局显著相关。在男性中观察到 BDI 评分和 BDI 评分≥10 与更高的发生此复合结局的概率之间存在显著的性别交互作用。BDI 评分与男性发生此复合结局的概率显著相关，但与女性无关。BDI 评分≥10 与男性发生此复合结局呈正相关，但与女性呈负相关。探索性分析确定了此复合结局的 BDI≥10×ADM 使用的交互作用在男性和女性中存在差异。与既无 BDI 评分≥10 也无 ADM 使用的患者相比，BDI 评分≥10 且同时使用 ADM 的男性发生该结局的概率增加了 60%，而 BDI 评分≥10 且同时使用 ADM 的女性发生该结局的概率降低了 50%。
结论
抑郁症状和 ADM 使用与 CVD 发病的关联在性别上的差异值得进一步研究。
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