Khalfan Anisa F, Campisi Susan C, Lo Ronda F, McCrindle Brian W, Korczak Daphne J
SickKids Research Institute, Toronto, Canada.
Hospital for Sick Children, Toronto, Canada.
JAACAP Open. 2024 May 20;3(2):291-301. doi: 10.1016/j.jaacop.2024.04.004. eCollection 2025 Jun.
Adolescents with major depressive disorder (MDD) are at increased risk of premature atherosclerosis and cardiovascular disease (CVD). The ability to identify adolescents with MDD who are at increased CVD risk would facilitate personalized interventions and advance knowledge regarding the MDD-CVD association. This study aimed to identify adolescent MDD endotypes of increased CVD risk.
Youth with MDD (n = 189; 74% female; mean [SD] age 15.03 [1.85] years) were recruited through an outpatient psychiatry program in a large urban hospital. Individual and family (demographics, depression, anxiety symptoms, family conflict), physical examination (vital signs, body mass index), and laboratory (lipid profile, glucose, C-reactive protein) data were collected. Using demographic, clinical, and laboratory data, k-means clustering was performed; a subsequent model included only lipids. Continuous and categorical measures were compared between clusters.
The model containing all variables yielded 1 high and 1 low CVD risk cluster, which differed significantly in ethnicity, anthropometrics, laboratory data, and family conflict, but not in depression or anxiety severity. The lipid-only model yielded 2 high and 2 low CVD risk clusters that differed significantly in sex, ethnicity, body mass index, lipids, depression, and anxiety severity. Of the 2 CVD risk clusters, one was indicative of increased cardiometabolic risk, while the other comprised adolescents with MDD who had high low-density lipoprotein and no other cardiovascular risk factors.
Endotypes of adolescent MDD associated with varying levels of CVD risk were identified. Results highlight the heterogeneity of adolescent MDD and the need for precision medicine approaches in management of MDD to improve both CVD and depression outcomes.
患有重度抑郁症（MDD）的青少年患过早动脉粥样硬化和心血管疾病（CVD）的风险增加。识别出CVD风险增加的患有MDD的青少年，将有助于进行个性化干预，并推进关于MDD与CVD关联的知识。本研究旨在识别出CVD风险增加的青少年MDD内型。
通过一家大型城市医院的门诊精神病学项目招募了患有MDD的青少年（n = 189；74%为女性；平均[标准差]年龄15.03[1.85]岁）。收集了个人和家庭（人口统计学、抑郁、焦虑症状、家庭冲突）、体格检查（生命体征、体重指数）以及实验室（血脂谱、血糖、C反应蛋白）数据。使用人口统计学、临床和实验室数据进行k均值聚类；后续模型仅纳入了血脂数据。对各聚类之间的连续和分类指标进行了比较。
包含所有变量的模型产生了1个高CVD风险聚类和1个低CVD风险聚类，这两个聚类在种族、人体测量学、实验室数据和家庭冲突方面存在显著差异，但在抑郁或焦虑严重程度方面没有差异。仅包含血脂的模型产生了2个高CVD风险聚类和2个低CVD风险聚类，它们在性别、种族、体重指数、血脂、抑郁和焦虑严重程度方面存在显著差异。在这2个CVD风险聚类中，一个表明心脏代谢风险增加，而另一个聚类中的患有MDD的青少年具有高低密度脂蛋白且无其他心血管风险因素。
识别出了与不同程度CVD风险相关的青少年MDD内型。结果凸显了青少年MDD的异质性，以及在MDD管理中采用精准医学方法以改善CVD和抑郁结局的必要性。
