Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
J Psychosom Res. 2021 Oct;149:110572. doi: 10.1016/j.jpsychores.2021.110572. Epub 2021 Jul 16.
To determine if there is a synergistic effect between clinically relevant depressive symptoms and cardiovascular risk factors that disproportionately increases the risk of cardiovascular disease (CVD) among older adults with depressive symptoms.
Data were obtained from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study. N = 3091 respondents with up to seven years of follow-up were included. Incident CVD was based on self-report, medication use, general practitioners' diagnoses and causes of death. A score of ≥16 points on the Center for Epidemiological Studies Depression Scale indicated clinically relevant depressive symptoms. Risk factors included were sex, education, obesity, smoking, alcohol use, physical inactivity and diabetes mellitus. Data were analysed with Cox regression models. Measures of multiplicative and additive interaction were calculated to determine if the presence of both depressive symptoms and a risk factor amplified the risk of CVD.
Of all participants, 12.6% had clinically relevant depressive symptoms and, after a median follow-up of six years, 15.7% developed CVD. Only the additive interaction between physical inactivity and depressive symptoms was statistically significant and explained 40.6% of the CVD risk among inactive persons with depressive symptoms.
In the general population, we did not detect synergistic effects for most risk factors. However, older adults with clinically relevant depressive symptoms and a physically inactive lifestyle appeared to be at a particularly high risk to develop CVD and may represent an important target for cardiovascular prevention.
确定在患有抑郁症状的老年人中，临床相关抑郁症状与心血管危险因素之间是否存在协同作用，这种协同作用是否不成比例地增加了心血管疾病（CVD）的风险。
数据来自阿姆斯特丹纵向老龄化研究，这是一项纵向队列研究。共纳入了 3091 名有 7 年随访的应答者。根据自我报告、药物使用、全科医生的诊断和死因确定心血管疾病的发生情况。中心流行病学研究抑郁量表的得分≥16 分表示存在临床相关的抑郁症状。危险因素包括性别、教育程度、肥胖、吸烟、饮酒、缺乏身体活动和糖尿病。采用 Cox 回归模型进行数据分析。计算了乘法和加法交互作用的指标，以确定抑郁症状和危险因素的同时存在是否放大了 CVD 的风险。
所有参与者中，12.6%存在临床相关的抑郁症状，在中位数为 6 年的随访后，有 15.7%发生了 CVD。只有不活动和抑郁症状之间的加法交互作用具有统计学意义，解释了不活跃且有抑郁症状的人群中 40.6%的 CVD 风险。
在一般人群中，我们没有发现大多数危险因素的协同作用。然而，患有临床相关抑郁症状和不活跃生活方式的老年人似乎面临着特别高的 CVD 发病风险，他们可能是心血管预防的一个重要目标人群。
