Post Doc, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.
Psychiatric Center Copenhagen, Department O; and Institute of Clinical Medicine, University of Copenhagen, Denmark.
Br J Psychiatry. 2020 Aug;217(2):434-441. doi: 10.1192/bjp.2019.130.
Depression and cardiovascular diseases (CVDs) are common diseases and associated in a bidirectional manner.
To examine whether a bidirectional association between CVD and depression could be explained by shared risk factors, misclassification of disease measures or non-response.
A total of 10 population-based cohorts including 93 076 men and women (mean age 54.4 years, s.d. = 9.2) and an additional 10 510 men (mean age 51.2 years, s.d. = 0.3) were followed for subsequent depression, ischaemic heart disease (IHD) and stroke in the Danish National Patient Registry from health examinations between 1982 and 2015 and until end of follow-up in 2017-2018. Exposures were physicians' diagnoses of IHD, stroke, depression or self-reported chest pain, depression, use of antidepressant medication and the Major Depression Inventory at the time of study entry in the Metropolit study. Associations were analysed using Cox proportional hazard regression with disease as time-dependent variables.
IHD and stroke were associated with subsequent depression (hazard ratio (HR) for IHD: 1.79, 95% CI 1.43-2.23 and HR for stroke: 2.62, 95% CI 2.09-3.29) and the associations were present in both men and women. Adjustment for the shared risk factors socioeconomic status, lifestyle, body mass index, statin use and serum lipids did not change the risk estimates. Furthermore, depression was associated with higher risk of subsequent IHD (HR = 1.63, 95% CI 1.36-1.95) and stroke (HR = 1.94, 95% CI 1.63-2.30). The associations were also present when the analyses were based on self-reported disease measures or restricted to include non-responders.
The bidirectional association between CVD and depression was not explained by shared risk factors, misclassification or non-response.
抑郁和心血管疾病（CVD）是常见疾病，且呈双向关联。
探讨 CVD 和抑郁之间的双向关联是否可以用共同的风险因素、疾病测量的分类错误或无应答来解释。
共纳入 10 个人群为基础的队列，包括 93076 名男性和女性（平均年龄 54.4 岁，标准差=9.2）和另外 10510 名男性（平均年龄 51.2 岁，标准差=0.3），随访时间为 1982 年至 2015 年健康检查至 2017-2018 年随访结束，随访期间发生抑郁、缺血性心脏病（IHD）和中风。暴露因素为医生诊断的 IHD、中风、抑郁或研究时自我报告的胸痛、抑郁、使用抗抑郁药物和大都会研究中的 Major Depression Inventory。采用 Cox 比例风险回归分析，以疾病为时间依赖性变量进行分析。
IHD 和中风与随后的抑郁有关（IHD 的 HR：1.79，95%CI 1.43-2.23 和中风的 HR：2.62，95%CI 2.09-3.29），且在男性和女性中均存在。调整共同的风险因素社会经济地位、生活方式、体重指数、他汀类药物使用和血脂后，风险估计值没有改变。此外，抑郁与随后发生 IHD（HR=1.63，95%CI 1.36-1.95）和中风（HR=1.94，95%CI 1.63-2.30）的风险增加相关。当分析基于自我报告的疾病测量或限制为包括无应答者时，也存在这些关联。
CVD 和抑郁之间的双向关联不能用共同的风险因素、分类错误或无应答来解释。
