Department of Psycho-cardiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China.
National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China.
Pharmacol Res. 2022 Jan;175:106024. doi: 10.1016/j.phrs.2021.106024. Epub 2021 Dec 7.
This study aimed to investigate the association between cardiovascular drugs and depression/anxiety in patients with cardiovascular disease (CVD). This meta-analysis was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42020197839) and conducted in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. The PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were systematically searched to identify all available studies on this topic. Random-effects multivariate meta-regression was performed to investigate the sources of study heterogeneity. Review Manager version 5.3 and Stata 12.0 were used for data analyses. This meta-analysis included 54 studies with a total number of 212,640 patients. Overall, in patients with CVD, aspirin (odds ratio [OR]:0.91, 95% confidence interval [CI]:0.86-0.96, P = 0.02) was associated with a lower risk of depression, while calcium channel blockers (CCB) (OR:1.21, 95%CI:1.05-1.38, P = 0.008), diuretics (OR:1.34, 95%CI:1.14-1.58, P = 0.0005), and nitrate esters (OR:1.32, 95%CI:1.08-1.61, P = 0.006) were associated with a higher risk of depression, additionally, statin (OR:0.79, 95%CI:0.71-0.88, P < 0.0001) was associated with a lower risk of anxiety, but diuretics (OR:1.39, 95%CI:1.26-1.52, P < 0.00001) was associated with a higher risk of anxiety. Subgroup analysis presented that, in patients with hypertension, β-blockers were associated with a higher risk of depression (OR:1.45, 95%CI:1.26-1.67, P < 0.00001); in patients with coronary artery disease (CAD), statin (OR:0.77, 95%CI:0.59-0.99, P = 0.04), and aspirin (OR:0.85, 95%CI:0.75-0.97, P = 0.02) were associated with a lower risk of depression, while CCB (OR:1.32, 95%CI:1.15-1.51, P < 0.0001) and diuretics (OR:1.36, 95%CI:1.12-1.64, P = 0.002) were associated with a higher risk of depression, additionally, diuretics was associated with a higher risk of anxiety (OR:1.41, 95%CI:1.28-1.55, P < 0.00001); in patients with heart failure, nitrate esters (OR:1.93, 95%CI:1.19-3.13, P = 0.007), and diuretics (OR:1.58, 95%CI: 1.02-2.43, P = 0.04) were associated with a higher risk of depression. The use of cardiovascular drugs should be considered when evaluating depression or anxiety in patients with CVD to improve the care and treatment of these patients.
本研究旨在探讨心血管疾病（CVD）患者中心血管药物与抑郁/焦虑之间的关联。本荟萃分析已在 PROSPERO（国际前瞻性系统评价注册库；CRD42020197839）中注册，并按照 MOOSE（流行病学观察性研究荟萃分析）指南进行。通过系统检索 PubMed、EMBASE、Web of Science、中国国家知识基础设施、万方和 VIP 数据库，以确定关于该主题的所有现有研究。采用随机效应多元荟萃回归分析来探究研究异质性的来源。使用 Review Manager 版本 5.3 和 Stata 12.0 进行数据分析。本荟萃分析纳入了 54 项研究，共涉及 212640 名患者。总体而言，在 CVD 患者中，阿司匹林（比值比 [OR]：0.91，95%置信区间 [CI]：0.86-0.96，P=0.02）与抑郁风险降低相关，而钙通道阻滞剂（CCB）（OR：1.21，95%CI：1.05-1.38，P=0.008）、利尿剂（OR：1.34，95%CI：1.14-1.58，P=0.0005）和硝酸酯类（OR：1.32，95%CI：1.08-1.61，P=0.006）与抑郁风险升高相关，此外，他汀类药物（OR：0.79，95%CI：0.71-0.88，P<0.0001）与焦虑风险降低相关，但利尿剂（OR：1.39，95%CI：1.26-1.52，P<0.00001）与焦虑风险升高相关。亚组分析表明，在高血压患者中，β受体阻滞剂与抑郁风险升高相关（OR：1.45，95%CI：1.26-1.67，P<0.00001）；在冠心病（CAD）患者中，他汀类药物（OR：0.77，95%CI：0.59-0.99，P=0.04）和阿司匹林（OR：0.85，95%CI：0.75-0.97，P=0.02）与抑郁风险降低相关，而 CCB（OR：1.32，95%CI：1.15-1.51，P<0.0001）和利尿剂（OR：1.36，95%CI：1.12-1.64，P=0.002）与抑郁风险升高相关，此外，利尿剂与焦虑风险升高相关（OR：1.41，95%CI：1.28-1.55，P<0.00001）；在心力衰竭患者中，硝酸酯类（OR：1.93，95%CI：1.19-3.13，P=0.007）和利尿剂（OR：1.58，95%CI：1.02-2.43，P=0.04）与抑郁风险升高相关。在评估 CVD 患者的抑郁或焦虑时，应考虑使用心血管药物，以改善这些患者的护理和治疗。
