Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie Sociale, Paris F75012, France.
INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France.
Eur Heart J Cardiovasc Pharmacother. 2021 Jul 23;7(4):280-286. doi: 10.1093/ehjcvp/pvaa124.
Depression is associated with increased risk of cardiovascular disease (CVD) and the role of poor medical adherence is mostly unknown. We studied the association between depressive symptoms and non-adherence to medications targeting treatable cardiovascular risk factors in the CONSTANCES population-based French cohort.
We used CONSTANCES data linked to the French national healthcare database to study the prospective association between depressive symptoms (assessed at inclusion with the Center for Epidemiological Studies Depression scale) and non-adherence to medications (less than 80% of trimesters with at least one drug dispensed) treating type 2 diabetes, hypertension, and dyslipidaemia over 36 months of follow-up. Binary logistic regression models were adjusted for socio-demographics, body mass index, and personal history of CVD at inclusion. Among 4998 individuals with hypertension, 793 with diabetes, and 3692 with dyslipidaemia at baseline, respectively 13.1% vs. 11.5%, 10.5% vs. 5.8%, and 29.0% vs. 27.1% of those depressed vs. those non-depressed were non-adherent over the first 18 months of follow-up (15.9% vs. 13.6%, 11.1% vs. 7.4%, and 34.8% vs. 36.6% between 19 and 36 months). Adjusting for all covariates, depressive symptoms were neither associated with non-adherence to medications for hypertension, diabetes, and dyslipidaemia over the first 18 months of follow-up, nor afterwards. Depressive symptoms were only associated with non-adherence to anti-diabetic medications between the first 3-6 months of follow-up.
Non-adherence to medications targeting treatable cardiovascular risk factors is unlikely to explain much of the association between depressive symptoms and CVD at a population level. Clinicians are urged to search for and treat depression in individuals with diabetes to foster medications adherence.
抑郁与心血管疾病（CVD）风险增加相关，而药物依从性差的作用大多尚不清楚。我们研究了 CONSTANCES 基于人群的法国队列中抑郁症状与针对可治疗心血管风险因素的药物不依从之间的关系。
我们使用 CONSTANCES 数据与法国国家医疗保健数据库相关联，研究了抑郁症状（在纳入时使用流行病学研究中心抑郁量表评估）与在 36 个月的随访期间治疗 2 型糖尿病、高血压和血脂异常的药物不依从（少于 80%的季度至少有一种药物配药）之间的前瞻性关联。二元逻辑回归模型调整了纳入时的社会人口统计学、体重指数和心血管疾病个人史。在基线时有高血压的 4998 人、糖尿病的 793 人和血脂异常的 3692 人分别有 13.1%与 11.5%、10.5%与 5.8%、29.0%与 27.1%的抑郁患者与非抑郁患者在随访的前 18 个月内不依从（15.9%与 13.6%、11.1%与 7.4%、34.8%与 36.6%在 19 至 36 个月之间）。调整所有协变量后，抑郁症状与随访前 18 个月内的高血压、糖尿病和血脂异常药物不依从之间既没有关联，也没有在之后关联。抑郁症状仅与随访前 3-6 个月的抗糖尿病药物不依从相关。
药物依从性差不太可能在人群水平上解释抑郁症状与 CVD 之间的大部分关联。临床医生被敦促在患有糖尿病的个体中寻找并治疗抑郁，以促进药物依从性。
