Martha S. Pitzer Center for Women, Children, & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States.
Martha S. Pitzer Center for Women, Children, & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States.
Psychoneuroendocrinology. 2019 Nov;109:104369. doi: 10.1016/j.psyneuen.2019.06.020. Epub 2019 Jul 4.
African Americans are at heightened risk for coronary heart disease (CHD), with biologic pathways poorly understood. We examined the role of allostatic load (AL) in the association of depressive symptoms with incident CHD among 2,670 African American men and women in the prospective Jackson Heart Study. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CES-D). Incident CHD was ascertained by self-report, death certificate survey, and adjudicated medical record surveillance. Baseline AL was quantified using biologic parameters of metabolic, cardiovascular, immune, and neuroendocrine subsystems and as a combined meta-factor. Sequential models adjusted for demographic, socioeconomic, and behavioral covariates, stratified to examine differences by sex. Greater depressive symptomatology was associated with greater metabolic, cardiovascular, and immune AL (p-values≤0.036) and AL meta-factor z-scores (p = 0.007), with findings driven by observations among females. Each 1-point increase in baseline depressive symptomatology, and 1-SD increase in metabolic AL, neuroendocrine AL, and AL meta-factor z-scores was associated with 3.3%, 88%, 39%, and 130% increases in CHD risk, respectively (p-values <0.001). Neuroendocrine AL and AL meta-factor scores predicted incident CHD among males but not females in stratified analyses. Metabolic AL partially mediated the association of depressive symptoms with incident CHD (5.79% mediation, p = 0.044), a finding present among females (p = 0.016) but not males (p = 0.840). Among African American adults, we present novel findings of an association between depressive symptomatology and incident CHD, partially mediated by metabolic AL. These findings appear to be unique to females, an important consideration in the design of targeted interventions for CHD prevention.
非裔美国人患冠心病（CHD）的风险较高，但生物学途径尚不清楚。我们研究了在前瞻性的杰克逊心脏研究中，2670 名非裔美国男性和女性中，压力负荷（AL）在抑郁症状与 CHD 事件之间的关联中的作用。抑郁症状使用流行病学研究中心抑郁量表（CES-D）进行量化。通过自我报告、死亡证明调查和经裁判的医疗记录监测确定 CHD 事件。使用代谢、心血管、免疫和神经内分泌子系统的生物学参数以及综合元因素来量化基线 AL。通过对人口统计学、社会经济和行为因素进行调整的顺序模型进行调整，按性别分层以检查差异。更严重的抑郁症状与更高的代谢、心血管和免疫 AL（p 值≤0.036）和 AL 元因素 z 分数（p=0.007）相关，这些发现主要来自女性。基线抑郁症状增加 1 分，代谢 AL、神经内分泌 AL 和 AL 元因素 z 分数增加 1 个标准差，分别与 CHD 风险增加 3.3%、88%、39%和 130%相关（p 值<0.001）。在分层分析中，神经内分泌 AL 和 AL 元因素评分可预测男性而非女性的 CHD 事件。代谢 AL 部分介导了抑郁症状与 CHD 事件之间的关联（5.79%的中介作用，p=0.044），这一发现存在于女性（p=0.016）但不存在于男性（p=0.840）中。在非裔美国成年人中，我们提出了抑郁症状与 CHD 事件之间存在关联的新发现，这部分由代谢 AL 介导。这些发现似乎仅存在于女性中，这是针对 CHD 预防的靶向干预措施设计的重要考虑因素。
