Birmingham City University, Faculty of Business, Law and Social Sciences, Birmingham B4 7BD, UK.
Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
Diabetes Res Clin Pract. 2019 Oct;156:107816. doi: 10.1016/j.diabres.2019.107816. Epub 2019 Aug 14.
To examine the association of comorbid occurrence of diabetes and depression with risk of cardiovascular endpoints including cardiovascular mortality, coronary heart disease and stroke.
A systematic review and metaanalysis. We searched PUBMED/MEDLINE, Medscape, Cochrane Library, CINAHL, EMBASE and Scopus databases assessing cardiac events and mortality associated with depression in diabetes up until 1 December 2018. Pooled hazard ratios were calculated using random- effects models.
Nine studies met the inclusion criteria. The combined pooled hazard ratios showed a significant association of cardiac events in people with depression and type 2 diabetes, compared to those with type 2 diabetes alone. For cardiovascular mortality the pooled hazard ratio was 1.48 (95% CI: 1.185, 1.845), p = 0.001, for coronary heart disease 1.37 (1.165, 1.605), p < 0.001 and for stroke 1.33 (1.291, 1.369), p < 0.001. Heterogeneity was high in the meta-analysis for stroke events (I-squared = 84.7%) but was lower for coronary heart disease and cardiovascular mortality (15% and 43.4% respectively). Meta-regression analyses showed that depression was not significantly associated with the study level covariates mean age, duration of diabetes, length of follow-up, BMI, sex and ethnicity (p < 0.05 for all models). Only three studies were found that examined the association of depression in type 1 diabetes, there was a high degree of heterogeneity and data synthesis was not conducted for these studies.
We have demonstrated a 47.9% increase in cardiovascular mortality, 36.8% increase in coronary heart disease and 32.9% increase in stroke in people with diabetes and comorbid depression. The presence of depression in a person with diabetes should trigger the consideration of evidence-based therapies for cardiovascular disease prevention irrespective of the baseline risk of cardiovascular disease or duration of diabetes.
探讨糖尿病和抑郁症共病发生与心血管终点事件（包括心血管死亡率、冠心病和中风）风险的相关性。
系统回顾和荟萃分析。我们检索了 PUBMED/MEDLINE、Medscape、Cochrane 图书馆、CINAHL、EMBASE 和 Scopus 数据库，评估了截至 2018 年 12 月 1 日与糖尿病相关的抑郁与心脏事件和死亡率之间的关系。使用随机效应模型计算合并的风险比。
有 9 项研究符合纳入标准。合并的风险比表明，与单纯 2 型糖尿病患者相比，合并抑郁症的 2 型糖尿病患者发生心脏事件的风险显著增加。对于心血管死亡率，合并的风险比为 1.48（95%CI：1.185，1.845），p=0.001，对于冠心病为 1.37（1.165，1.605），p<0.001，对于中风为 1.33（1.291，1.369），p<0.001。荟萃分析中中风事件的异质性较高（I-squared=84.7%），但对于冠心病和心血管死亡率则较低（分别为 15%和 43.4%）。Meta 回归分析表明，抑郁与研究水平的协变量（平均年龄、糖尿病病程、随访时间、BMI、性别和种族）无显著相关性（所有模型的 p 值均>0.05）。仅发现 3 项研究检查了 1 型糖尿病中抑郁的相关性，这些研究存在高度异质性，因此未对这些研究进行数据综合。
我们发现患有糖尿病和共病抑郁症的患者心血管死亡率增加 47.9%，冠心病增加 36.8%，中风增加 32.9%。患有糖尿病的患者出现抑郁应提示考虑采用基于证据的治疗方法预防心血管疾病，而不论其心血管疾病的基线风险或糖尿病病程如何。
