抑郁症状与南方社区队列研究中心衰事件风险。

Depressive Symptoms and Incident Heart Failure Risk in the Southern Community Cohort Study.

机构信息

Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

出版信息

JACC Heart Fail. 2022 Apr;10(4):254-262. doi: 10.1016/j.jchf.2021.11.007. Epub 2022 Feb 9.

DOI:10.1016/j.jchf.2021.11.007

PMID:35361444

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8976159/

Abstract

OBJECTIVES

This study aims to examine whether greater frequency of depressive symptoms associates with increased risk of incident heart failure (HF).

BACKGROUND

Depressive symptoms associate with adverse prognosis in patients with prevalent HF. Their association with incident HF is less studied, particularly in low-income and minority individuals.

METHODS

We studied 23,937 Black or White Southern Community Cohort Study participants (median age: 53 years, 70% Black, 64% women) enrolled between 2002 and 2009, without prevalent HF, receiving Centers for Medicare and Medicaid Services coverage. Cox models adjusted for traditional HF risk factors, socioeconomic and behavioral factors, social support, and antidepressant medications were used to quantify the association between depressive symptoms assessed at enrollment via the Center for Epidemiologic Studies Depression Scale (CESD-10) and incident HF ascertained from Centers for Medicare and Medicaid Services International Classification of Diseases-9th Revision (ICD-9) (code: 428.x) and ICD-10 (codes: I50, I110) codes through December 31, 2016.

RESULTS

The median CESD-10 score was 9 (IQR: 5 to 13). Over a median 11-year follow-up, 6,081 (25%) participants developed HF. The strongest correlates of CESD-10 score were antidepressant medication use, age, and socioeconomic factors, rather than traditional HF risk factors. Greater frequency of depressive symptoms associated with increased incident HF risk (per 8-U higher CESD-10 HR: 1.04; 95% CI: 1.00 to 1.09; P = 0.038) without variation by race or sex. The association between depressive symptoms and incident HF varied by antidepressant use (interaction-P = 0.03) with increased risk among individuals not taking antidepressants.

CONCLUSIONS

In this high-risk, low-income, cohort of predominantly Black participants, greater frequency of depressive symptoms significantly associates with higher risk of incident HF.

摘要

目的

本研究旨在探讨抑郁症状的发生频率是否与心力衰竭（HF）事件的发生风险增加有关。

背景

抑郁症状与现患 HF 患者的不良预后相关。但对其与 HF 事件的相关性研究较少，尤其是在低收入和少数族裔人群中。

方法

我们研究了 23937 名黑种人或白种人南方社区队列研究参与者（中位年龄：53 岁，70%为黑种人，64%为女性），他们于 2002 年至 2009 年期间入组，没有现患 HF，且接受联邦医疗保险和医疗补助服务中心的保险覆盖。通过使用 Cox 模型调整传统 HF 风险因素、社会经济和行为因素、社会支持以及抗抑郁药物，来量化通过流行病学研究中心抑郁量表（CESD-10）在入组时评估的抑郁症状（CESD-10）与联邦医疗保险和医疗补助服务中心国际疾病分类第 9 版（ICD-9）（代码：428.x）和 ICD-10（代码：I50、I110）代码确定的 HF 事件之间的关联，HF 事件随访至 2016 年 12 月 31 日。

结果

CESD-10 的中位数为 9（IQR：5 至 13）。在中位 11 年的随访期间，有 6081 名（25%）参与者发生 HF。CESD-10 评分的最强相关因素是抗抑郁药物的使用、年龄和社会经济因素，而非传统 HF 风险因素。抑郁症状越频繁，HF 事件的发生风险越高（每增加 8 分 CESD-10，HR：1.04；95%CI：1.00 至 1.09；P = 0.038），且与种族或性别无关。抑郁症状与 HF 事件的关联因抗抑郁药物的使用而异（交互 P = 0.03），在未使用抗抑郁药物的个体中，HF 事件的发生风险增加。