Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Affect Disord. 2024 Sep 15;361:182-188. doi: 10.1016/j.jad.2024.06.022. Epub 2024 Jun 10.
Depression has emerged as a modifiable risk factor for cardiovascular disease (CVD). However, evidence on whether depressive symptoms measured using a self-report questionnaire are associated with CVD incidence is scarce. Therefore, we aimed to investigate the association between depressive symptoms and CVD risk using data from national health examinations and insurance claim records.
This retrospective cohort study included participants who underwent the Korean National Screening Program for Transitional Ages at age 66 years between 2007 and 2017. The presence of depressive symptoms was defined as affirmative responses to any of three questions (loss of activities and interests, worthlessness, and hopelessness) selected from the Geriatric Depression Scale. Incident composite CVD event included myocardial infarction, stroke, heart failure, and CVD death. The association between depressive symptoms and CVD risk was evaluated using hazard ratios (HRs) and 95 % confidence intervals (CIs) estimated with Cox proportional hazards models.
Among 88,765 participants (48.5 % women) aged 66 years, 4036 incident CVD events occurred during a mean follow-up of 6.8 years. Participants with depressive symptoms had a significantly higher risk of CVD than those without depressive symptoms (adjusted HR = 1.16 [95 % CI: 1.07-1.24]). The three individual depressive symptoms showed similar associations with CVD risk (loss of activities and interests, adjusted HR = 1.17 [95 % CI: 1.08-1.26]; worthlessness, 1.15 [1.03-1.29]; hopelessness, 1.13 [1.01-1.26]).
The study was limited to participants aged 66 years. Despite extensive adjustment for potential confounders and multiple sensitivity analyses, residual confounding and reverse causality could not be ruled out.
The presence of depressive symptoms was associated with an increased risk of CVD. Screening for depressive symptoms in the general population may effectively mitigate the burden of CVD.
抑郁已成为心血管疾病（CVD）的可改变风险因素。然而，关于使用自我报告问卷测量的抑郁症状是否与 CVD 发病率相关的证据很少。因此，我们旨在使用国家健康检查和保险索赔记录的数据来研究抑郁症状与 CVD 风险之间的关系。
这项回顾性队列研究纳入了 2007 年至 2017 年间在韩国国家转型期筛查计划中接受检查的年龄为 66 岁的参与者。抑郁症状的存在通过对从老年抑郁量表中选择的三个问题（活动和兴趣丧失、无价值感和绝望感）的肯定回答来定义。复合 CVD 事件包括心肌梗死、中风、心力衰竭和 CVD 死亡。使用 Cox 比例风险模型估计的风险比（HRs）和 95%置信区间（CIs）来评估抑郁症状与 CVD 风险之间的关系。
在 88765 名年龄为 66 岁的参与者（48.5%为女性）中，在平均 6.8 年的随访期间发生了 4036 例 CVD 事件。与没有抑郁症状的参与者相比，有抑郁症状的参与者发生 CVD 的风险显著更高（调整后的 HR=1.16 [95%CI：1.07-1.24]）。三种个体抑郁症状与 CVD 风险的关联相似（活动和兴趣丧失，调整后的 HR=1.17 [95%CI：1.08-1.26]；无价值感，1.15 [1.03-1.29]；绝望感，1.13 [1.01-1.26]）。
该研究仅限于 66 岁的参与者。尽管进行了广泛的潜在混杂因素调整和多次敏感性分析，但仍不能排除残留混杂和反向因果关系。
抑郁症状的存在与 CVD 风险增加相关。在普通人群中筛查抑郁症状可能有效减轻 CVD 的负担。
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