Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
JAMA Psychiatry. 2020 Jun 1;77(6):598-606. doi: 10.1001/jamapsychiatry.2019.4712.
Previous research has linked a history of depression with arterial stiffness (AS) during midlife.
To assess the association of depression with elevated midlife AS and to investigate the extent to which this association is mediated via metabolic syndrome (MetS).
DESIGN, SETTINGS, AND PARTICIPANTS: This population-based retrospective cohort study analyzed data collected between March 2006 and December 2010 from 124 445 participants aged 40 to 69 years from the UK Biobank. Participants without data on AS at baseline (n = 332 780) or who reported a previous diagnosis of cardiovascular disease (n = 45 374) were not eligible. Data analysis was performed from May to August 2019.
Lifetime history of depression was assessed via verbal interview and linked hospital-based clinical depression diagnosis. Metabolic syndrome was defined as the presence of 3 or more of hypertension, dyslipidemia, hyperglycemia, hypertriglyceridemia, and unhealthy waist circumference.
Peripherally assessed AS index (ASI) using digital photoplethysmography.
Of 124 445 included participants with ASI assessed, 71 799 (57.7%) were women, and the mean (SD) age was 56 (8) years. A total of 10 304 participants (8.3%) reported a history of depression. Study findings indicated a significant direct association between depression and ASI levels (β = 0.25; 95% CI, 0.17-0.32). A significant indirect association was also observed between depression and ASI levels (β = 0.10; 95% CI, 0.07-0.13), indicating that 29% of the association of depression with ASI was mediated by MetS. The proportion of mediation increased to 37% when C-reactive protein was added to the MetS criteria (direct association: β = 0.21; 95% CI, 0.15-0.28; indirect association: β = 0.13; 95% CI, 0.10-0.17). Concerning components of MetS, the strongest indirect association was for waist circumference, accounting for 25% of the association between depression and ASI levels (direct association: β = 0.26; 95% CI, 0.18-0.34; indirect association: β = 0.09; 95% CI, 0.06-0.11). Among men, hypertriglyceridemia accounted for 19% of the association between depression and ASI (direct association: β = 0.22; 95% CI, 0.05-0.40; indirect association: β = 0.05; 95% CI, 0.02-0.08).
One-third of the association of depression with elevated ASI levels during midlife may be accounted for by combined MetS and inflammatory processes. Unhealthy waist circumference and hypertriglyceridemia emerged as the most important potential targets for preventive interventions within women and men, respectively.
先前的研究表明，抑郁史与中年时期的动脉僵硬（AS）有关。
评估抑郁与中年时期 AS 升高的相关性，并探讨这种相关性在多大程度上通过代谢综合征（MetS）来介导。
设计、设置和参与者：这项基于人群的回顾性队列研究分析了 2006 年 3 月至 2010 年 12 月期间，来自英国生物库的 124445 名年龄在 40 至 69 岁的参与者的数据。基线时没有 AS 数据的参与者（n=332780）或报告有心血管疾病既往诊断的参与者（n=45374）不符合条件。数据分析于 2019 年 5 月至 8 月进行。
通过口头访谈和与医院相关的临床抑郁诊断来评估一生中的抑郁史。代谢综合征定义为存在高血压、血脂异常、高血糖、高甘油三酯血症和不健康的腰围 3 种或更多种。
使用数字光体积描记法评估外周动脉僵硬度指数（ASI）。
在评估了 ASI 的 124445 名参与者中，71799 名（57.7%）为女性，平均（SD）年龄为 56（8）岁。共有 10304 名参与者（8.3%）报告有抑郁史。研究结果表明，抑郁与 ASI 水平之间存在显著的直接关联（β=0.25；95%CI，0.17-0.32）。还观察到抑郁与 ASI 水平之间存在显著的间接关联（β=0.10；95%CI，0.07-0.13），这表明抑郁与 ASI 之间的关联有 29%是通过 MetS 来介导的。当将 C 反应蛋白添加到 MetS 标准中时，中介比例增加到 37%（直接关联：β=0.21；95%CI，0.15-0.28；间接关联：β=0.13；95%CI，0.10-0.17）。关于 MetS 的组成部分，腰围的间接关联最强，占抑郁与 ASI 水平之间关联的 25%（直接关联：β=0.26；95%CI，0.18-0.34；间接关联：β=0.09；95%CI，0.06-0.11）。在男性中，高甘油三酯血症占抑郁与 ASI 之间关联的 19%（直接关联：β=0.22；95%CI，0.05-0.40；间接关联：β=0.05；95%CI，0.02-0.08）。
抑郁与中年时期 ASI 升高之间三分之一的相关性可能是由 MetS 和炎症过程共同介导的。在女性中，不健康的腰围和高甘油三酯血症分别是预防干预的最重要潜在目标；在男性中则是高甘油三酯血症。
