压力知觉与心力衰竭事件的关联。
Association of Perceived Stress With Incident Heart Failure.
机构信息
Department of Medicine, Weill Cornell Medicine, New York, New York.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
出版信息
J Card Fail. 2022 Sep;28(9):1401-1410. doi: 10.1016/j.cardfail.2022.04.013. Epub 2022 May 11.
BACKGROUND
The relationship between psychological stress and heart failure (HF) has not been well studied. We sought to assess the relationship between perceived stress and incident HF.
METHODS
We used data from the national REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a large prospective biracial cohort study that enrolled community-dwellers aged 45 years and older between 2003 and 2007, with follow-up. We included participants free of suspected prevalent HF who completed the Cohen 4-item Perceived Stress Scale (PSS-4). Our outcome variables were incident HF event, HF with reduced ejection fraction events, and HF with preserved ejection fraction events. We estimated Cox proportional hazard models to determine if PSS-4 quartiles were independently associated with incident HF events, adjusting for sociodemographics, social support, unhealthy behaviors, comorbid conditions, and physiologic parameters. We also tested interactions by baseline statin use, given its anti-inflammatory properties.
RESULTS
Among 25,785 participants with a mean age of 64 ± 9.3 years, 55% were female and 40% were Black. Over a median follow-up of 10.1 years, 1109 ± 4.3% experienced an incident HF event. In fully adjusted models, the PSS-4 was not associated with HF or HF with reduced ejection fraction. However, PSS-4 quartiles 2-4 (compared with the lowest quartile) were associated with incident HF with preserved ejection fraction (Q2 hazard ratio 1.37, 95% confidence interval 1.00-1.88; Q3 hazard ratio 1.42, 95% confidence interval 1.03-1.95; Q4 hazard ratio 1.41, 95% confidence interval 1.04-1.92). Notably, this association was attenuated among participants who took a statin at baseline (P for interaction = .07).
CONCLUSIONS
Elevated perceived stress was associated with incident HF with preserved ejection fraction but not HF with reduced ejection fraction.
背景
心理压力与心力衰竭（HF）之间的关系尚未得到充分研究。我们旨在评估感知压力与 HF 事件的关系。
方法
我们使用来自全国 Reasons for Geographic And Racial Differences in Stroke（REGARDS）研究的数据，这是一项大型前瞻性的、种族混杂的队列研究，于 2003 年至 2007 年间招募了年龄在 45 岁及以上的社区居民，进行了随访。我们纳入了完成了 Cohen 4 项感知压力量表（PSS-4）且没有疑似 HF 既往史的参与者。我们的结局变量是 HF 事件、射血分数降低的 HF 事件和射血分数保留的 HF 事件。我们使用 Cox 比例风险模型来确定 PSS-4 四分位数是否与 HF 事件的发生独立相关，调整了社会人口统计学、社会支持、不健康行为、合并症和生理参数。我们还根据基线他汀类药物的使用情况进行了交互作用检验，因为他汀类药物具有抗炎特性。
结果
在 25785 名平均年龄为 64±9.3 岁的参与者中，55%为女性，40%为黑人。在中位随访 10.1 年期间，1109±4.3%的参与者发生了 HF 事件。在充分调整的模型中，PSS-4 与 HF 或射血分数降低的 HF 无关。然而，PSS-4 四分位 2-4 组（与最低四分位组相比）与射血分数保留的 HF 事件独立相关（Q2 危险比 1.37，95%置信区间 1.00-1.88；Q3 危险比 1.42，95%置信区间 1.03-1.95；Q4 危险比 1.41，95%置信区间 1.04-1.92）。值得注意的是，这种关联在基线时服用他汀类药物的参与者中减弱（交互作用 P 值=0.07）。
结论
感知压力升高与射血分数保留的 HF 事件相关，但与射血分数降低的 HF 事件无关。
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