Nakada Shinya, Welsh Paul, Celis-Morales Carlos, Pell Jill P, Ho Frederick K
Schools of Health and Wellbeing (Nakada, Pell, Ho), and Cardiovascular and Metabolic Health (Welsh, Celis-Morales), University of Glasgow, Glasgow, UK; Human Performance Laboratory, Education, Physical Activity and Health Research Unit (Celis-Morales), Universidad Católica del Maule, Talca, Chile; Centro de Investigación en Medicina de Altura (CEIMA) (Celis-Morales), Universidad Arturo Prat, Iquique, Chile.
CMAJ. 2025 Jan 12;197(1):E1-E8. doi: 10.1503/cmaj.240996.
Anxiety and depression are associated with cardiovascular disease (CVD). We aimed to investigate whether adding measures of anxiety and depression to the American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) predictors improves the prediction of CVD risk.
We developed and internally validated risk prediction models using 60% and 40% of the cohort data from the UK Biobank, respectively. Mental health predictors included baseline depressive symptom score and self-reported and record-based history of anxiety and depression diagnoses before the baseline. We identified CVD events using hospital admission and death certificate data over a 10-year period from baseline. We determined incremental predictive values by adding the mental health predictors to the PREVENT predictors using Harrell's C-indices, sensitivity, specificity, and net reclassification improvement indices. We used a threshold of 10-year risk of incident CVD of greater than 5%.
Of the 502 366 UK Biobank participants, we included 195 489 in the derivation set and 130 326 in the validation set. In the validation set, the inclusion of all mental health measures, except self-reported anxiety, produced a very modest increase in the C-index and specificity while sensitivity remained unchanged. Among these mental health predictors, depressive symptom score produced the greatest improvements in both C-index (difference of 0.005, 95% confidence interval 0.004-0.006) and specificity (difference of 0.89%). Depressive symptom score showed similar small improvements in female and male validation sets.
Our findings suggest that the inclusion of measures of depression and anxiety in PREVENT would have little additional effect on the risk classification of CVD at the population level and may not be worthwhile.
焦虑和抑郁与心血管疾病（CVD）相关。我们旨在研究将焦虑和抑郁测量指标添加到美国心脏协会心血管疾病事件预测（PREVENT）预测因子中是否能改善对CVD风险的预测。
我们分别使用英国生物银行队列数据的60%和40%开发并进行了内部验证风险预测模型。心理健康预测因子包括基线抑郁症状评分以及基线前自我报告和基于记录的焦虑和抑郁诊断病史。我们使用从基线起10年期间的医院入院和死亡证明数据确定CVD事件。我们通过使用哈雷尔C指数、敏感性、特异性和净重新分类改善指数将心理健康预测因子添加到PREVENT预测因子中来确定增量预测值。我们使用10年新发CVD风险大于5%的阈值。
在502366名英国生物银行参与者中，我们将195489名纳入推导集，130326名纳入验证集。在验证集中，除自我报告的焦虑外，纳入所有心理健康测量指标使C指数和特异性略有增加，而敏感性保持不变。在这些心理健康预测因子中，抑郁症状评分在C指数（差异为0.005，95%置信区间0.004 - 0.006）和特异性（差异为0.89%）方面都有最大改善。抑郁症状评分在女性和男性验证集中显示出类似的小幅度改善。
我们的研究结果表明，在PREVENT中纳入抑郁和焦虑测量指标对人群层面CVD风险分类几乎没有额外影响，可能不值得。
