KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2021 Mar;37(3):382-390. doi: 10.1016/j.cjca.2020.08.019. Epub 2020 Aug 31.
Depressive symptoms (DS) disproportionately affect women with cardiac disease; however, no analyses have been conducted that would allow for focused sex-specific interventions.
Consecutively enrolled women (n = 663) were matched with men postcardiac revascularization at cardiac rehabilitation (CR) entry by primary diagnosis, age, and year of CR entry from database records (2006 to 2017). Multivariate analyses were conducted to determine predictors of DS (≥16 on the Center for Epidemiologic Studies Depression Scale) in all patients and men and women separately.
In bivariate analysis, women were more likely than men to have DS (30.2% vs 19.3%; P < 0.001) in the matched cohort. A greater proportion of women than men had DS in all 10-year age categories (P < 0.05) except youngest (<50 years; 37% vs 30.4%; P = 0.7) and oldest (≥80; 12.3% vs 10.3%; P = 0.8). DS peaked in women aged 50 to 59 (42.5%) and men <50 years (30.4%). In all patients, independent predictors of DS were younger age, lower cardiorespiratory fitness (VO), being unemployed, greater comorbidities, smoking, anxiolytics, antidepressants, not being married, but not sex. Shared predictors in women-only and men-only analyses were younger age, lower VO, antidepressants, and being unemployed. Unique predictors for women were obesity, smoking, and delayed CR entry and, for men, hypertension, myocardial infarction, anxiolytics, and not being married.
Despite matching for age and diagnosis, women were more likely to have DS than men. However, sex was not a predictor of DS in multivariate analyses. This suggests that the profile of women predisposes them to greater DS. Obesity, smoking, and greater delayed CR entry were unique correlates for women and targets for intervention.
抑郁症状（DS）不成比例地影响患有心脏病的女性；然而，尚未进行分析，无法针对特定性别进行干预。
连续入组的女性（n=663）在心脏康复（CR）入组时通过数据库记录（2006 年至 2017 年）按主要诊断、年龄和 CR 入组年份与男性进行匹配。对所有患者以及男性和女性分别进行多变量分析，以确定 DS（中心流行病学研究抑郁量表 [CES-D] ≥16）的预测因素。
在配对队列中，女性在二元分析中比男性更有可能出现 DS（30.2%比 19.3%；P < 0.001）。除最年轻（<50 岁；37%比 30.4%；P=0.7）和最年长（≥80 岁；12.3%比 10.3%；P=0.8）之外，所有年龄组的女性 DS 比例均高于男性（P<0.05）。DS 在女性 50 至 59 岁（42.5%）和男性<50 岁（30.4%）年龄组中达到高峰。在所有患者中，DS 的独立预测因素是年龄较小、心肺功能（VO₂）较低、失业、合并症较多、吸烟、抗焦虑药、抗抑郁药、未婚，但与性别无关。女性-only 和男性-only 分析中的共同预测因素是年龄较小、VO₂较低、抗抑郁药和失业。女性的独特预测因素是肥胖、吸烟和延迟 CR 入组，而男性的独特预测因素是高血压、心肌梗死、抗焦虑药和未婚。
尽管按年龄和诊断进行了匹配，但女性出现 DS 的可能性仍高于男性。然而，在多变量分析中，性别并不是 DS 的预测因素。这表明女性的特征使她们更容易出现 DS。肥胖、吸烟和延迟 CR 入组是女性的独特相关因素，也是干预的目标。
