Department of Medicine, MetroWest Medical Center, Framingham, MA, USA.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Cardiovasc Diabetol. 2023 May 18;22(1):115. doi: 10.1186/s12933-023-01809-4.
Few studies have assessed the correlation between coexisting mental disorders in participants with diabetes mellitus (DM) and the risk of heart failure (HF). Herein, we conducted a cohort study to determine the association between the accumulation of mental disorders in participants with DM and the risk of HF.
The Korean National Health Insurance Service records were assessed. 2,447,386 adults with DM who underwent health screening between 2009 and 2012 were analyzed. Participants with major depressive disorder, bipolar disorder, schizophrenia, insomnia, or anxiety disorders were included. In addition, participants were categorized based on the number of coexisting mental disorders. Each participant was followed until December 2018 or until the onset of HF. Cox proportional hazard modelling with confounding factors adjustment was conducted. In addition, a competing risk analysis was conducted. Subgroup analysis assessed the impact of clinical variables on the association between the accumulation of mental disorders and the risk of HF.
The median follow-up duration was 7.09 years. The accumulation of mental disorders was associated with a risk of HF (zero mental disorder (0), reference; 1 mental disorder, adjusted hazard ratio (aHR): 1.222, 95% confidence intervals (CI): 1.207-1.237; 2 mental disorders, aHR: 1.426, CI: 1.403-1.448; ≥3 mental disorders, aHR: 1.667, CI: 1.632-1.70. In the subgroup analysis, the strength of association was the strongest in the younger age group (< 40 years, 1 mental disorder, aHR 1.301, CI 1.143-1.481; ≥2 mental disorders, aHR 2.683, CI 2.257-3.190; 40-64 years, 1 mental disorder, aHR 1.289, CI 1.265-1.314; ≥2 mental disorders, aHR 1.762, CI 1.724-1.801; ≥65 years, 1 mental disorder, aHR 1.164, CI 1.145-1.183; ≥2 mental disorders, aHR 1.353, CI 1.330-1.377; P<0.001). In addition, income, BMI, hypertension, chronic kidney disease, history of cardiovascular disease, insulin use, and duration of DM showed significant interactions.
Comorbid mental disorders in participants with DM are associated with an increased risk of HF. In addition, the association was stronger in a younger age group. Participants with DM and mental disorders should be monitored with increased frequency for signs of HF; for which they have a higher risk than the general population.
很少有研究评估参与者中并存的精神障碍与糖尿病（DM）和心力衰竭（HF）风险之间的相关性。在此，我们进行了一项队列研究，以确定 DM 患者中并存精神障碍的积累与 HF 风险之间的关系。
评估了韩国国家健康保险服务记录。分析了 2447386 名 2009 年至 2012 年间接受健康筛查的 DM 成年人。包括患有重度抑郁症、双相情感障碍、精神分裂症、失眠或焦虑症的患者。此外，根据并存精神障碍的数量对参与者进行分类。每个参与者都随访至 2018 年 12 月或直至发生 HF。进行了具有混杂因素调整的 Cox 比例风险建模。此外，还进行了竞争风险分析。亚组分析评估了临床变量对并存精神障碍积累与 HF 风险之间关联的影响。
中位随访时间为 7.09 年。并存精神障碍与 HF 风险相关（无精神障碍（0），参考；1 种精神障碍，调整后的危险比（aHR）：1.222，95%置信区间（CI）：1.207-1.237；2 种精神障碍，aHR：1.426，CI：1.403-1.448；≥3 种精神障碍，aHR：1.667，CI：1.632-1.70。在亚组分析中，关联强度在年龄较小的组（<40 岁，1 种精神障碍，aHR 1.301，CI 1.143-1.481；≥2 种精神障碍，aHR 2.683，CI 2.257-3.190；40-64 岁，1 种精神障碍，aHR 1.289，CI 1.265-1.314；≥2 种精神障碍，aHR 1.762，CI 1.724-1.801；≥65 岁，1 种精神障碍，aHR 1.164，CI 1.145-1.183；≥2 种精神障碍，aHR 1.353，CI 1.330-1.377；P<0.001）。此外，收入、BMI、高血压、慢性肾脏病、心血管疾病史、胰岛素使用和 DM 持续时间均显示出显著的交互作用。
DM 患者并存的精神障碍与 HF 风险增加相关。此外，这种关联在年龄较小的人群中更强。患有 DM 和精神障碍的患者应更频繁地监测 HF 的迹象；他们比一般人群的风险更高。
