美国范斯坦医学研究所Karina W. Davidson联合英国剑桥大学Eric L. Harshfield团队研究了抑郁症状与心血管疾病的关系。2020年12月15日，该研究发表在《美国医学会杂志》上。

尚不确定抑郁症状是否与随后的心血管疾病（CVD）风险独立相关。为了描述抑郁症状和心血管疾病发病率之间的相关性，研究组对新兴风险因素合作研究（ERFC）中的162036名参与者和英国生物库401219名参与者的个人数据集进行了分析。这些参与者均有自我报告的抑郁症状信息，且基线时没有CVD史。

研究组使用经过验证的仪器记录抑郁症状。在各个研究中，ERFC得分与代表流行病学研究中心抑郁症（CES-D）的量表（范围0-60；≥16表示可能有抑郁症）相一致。英国生物库记录了2项患者健康调查表2（PHQ-2；范围为0-6；≥3表示可能是抑郁症）。主要结局为致命或非致命性冠心病（CHD）、中风和CVD。

ERFC队列中73％为女性，基线平均年龄为63岁，中位随访9.5年，共记录了5078例CHD和3932例中风事件。与冠心病、中风和CVD的相关性呈对数线性关系。抑郁评分每升高1-SD发生冠心病的风险比为1.07，中风为1.05，CVD为1.06。CES-D得分最高或最低五分位（几何平均CES-D得分，19分与1分）的参与者每10000人年CHD事件发生率分别为36.3例与29.0例，中风分别为28.0例与24.7例，CVD分别为62.8例与53.5例。

英国生物库队列中55％为女性，基线平均年龄为56岁，中位随访8.1年，共记录了4607例CHD和3253例中风事件。抑郁评分每升高1-SD发生冠心病的风险比为1.11，中风为1.10，CVD为1.10。PHQ-2得分为4分及以上与得分为0的参与者中每10000人年CHD事件发生率分别为20.9例与14.2例，中风分别为15.3例与10.2例，CVD分别为36.2例与24.5例。校正其他危险因素后，HR的大小和统计学意义未发生实质性变化。

该项大型队列分析结果表明，基线时抑郁症状（包括症状水平低于抑郁障碍阈值）与CVD发病率相关。

附：英文原文

Title: Association Between Depressive Symptoms and Incident Cardiovascular Diseases

Author: Eric L. Harshfield, Lisa Pennells, Joseph E. Schwartz, Peter Willeit, Stephen Kaptoge, Steven Bell, Jonathan A. Shaffer, Thomas Bolton, Sarah Spackman, Sylvia Wassertheil-Smoller, Frank Kee, Philippe Amouyel, Steven J. Shea, Lewis H. Kuller, Jussi Kauhanen, E. M. van Zutphen, Dan G. Blazer, Harlan Krumholz, Paul J. Nietert, Daan Kromhout, Gail Laughlin, Lisa Berkman, Robert B. Wallace, Leon A. Simons, Elaine M. Dennison, Elizabeth L. M. Barr, Haakon E. Meyer, Angela M. Wood, John Danesh, Emanuele Di Angelantonio, Karina W. Davidson, Emerging Risk Factors Collaboration

Issue&Volume: 2020/12/15

Abstract:

Importance  It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs).

Objective  To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood.

Design, Setting, and Participants  A pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162036 participants; 21 cohorts; baseline surveys, 1960-2008; latest follow-up, March 2020) and the UK Biobank (401219 participants; baseline surveys, 2006-2010; latest follow-up, March 2020). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline.

Exposures  Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder).

Main Outcomes and Measures  Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2). Hazard ratios (HRs) per 1-SD higher log CES-D or PHQ-2 adjusted for age, sex, smoking, and diabetes were reported.

Results  Among 162036 participants from the ERFC (73%, women; mean age at baseline, 63 years [SD, 9 years]), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years). Associations with CHD, stroke, and CVD were log linear. The HR per 1-SD higher depression score for CHD was 1.07 (95% CI, 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). The corresponding incidence rates per 10000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events. Among 401219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years [SD, 8 years]), 4607 CHD and 3253 stroke events were recorded (median follow-up, 8.1 years). The HR per 1-SD higher depression score for CHD was 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). The corresponding incidence rates per 10000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events. The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors.

Conclusions and Relevance  In a pooled analysis of 563255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest.

DOI: 10.1001/jama.2020.23068

Source: https://jamanetwork.com/journals/jama/article-abstract/2774050