Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Faculty of Health, University of Canberra, Australia.
Hellenic J Cardiol. 2020 Sep-Oct;61(5):321-328. doi: 10.1016/j.hjc.2019.10.017. Epub 2019 Nov 16.
The sex-specific effect of depressive symptomatology on 10-year first and recurrent cardiovascular disease (CVD) events was evaluated.
The Greek samples from ATTICA (2002-2012, n = 845 free-of-CVD subjects) and GREECS (2004-2014, n = 2,172 subjects with acute coronary syndrome (ACS)) prospective epidemiological studies with baseline psychological assessments were used for the first and the recurrent event, respectively. Depressive symptomatology was assessed at baseline, through Zung Self-Rating Depression Scale in the ATTICA study, and through the Center for Epidemiological Studies-Depression scale in the GREECS study.
ACS as well as free-of-CVD women scored significantly higher for depressive symptomatology. Men scored higher than women against first (19.7% vs. 11.7%) and subsequent CVD events (38.8% vs. 32.9%). In participants with depressive symptoms man-to-woman first and recurrent CVD event rate ratio was below 1, confirming that depressive women were more likely to have a CVD event than depressive men. Multiadjusted analysis revealed that depressive symptomatology had an independent aggravating effect on the first (hazard ratio (HR) = 2.72, 95% confidence interval (95% CI) 1.50, 9.12) and recurrent (HR = 1.31, 95% CI 1.01, 1.69) CVD events only in women. Mediation analysis in women revealed that 35% (23%, 44%) of excess first-CVD-event risk of depressive symptoms was attributed to conventional risk factors. The respective number for recurrent CVD events was 46% (23%, 53%); different patterns of ranking regarding the mediating effect corresponding to each adjustment factor were observed.
The present work augments prior evidence that psychological stressors possess important drivers of CVD onset and progression mainly in women, while it gives rise to research toward unidentified paths behind this claim.
评估抑郁症状对 10 年首次和复发性心血管疾病（CVD）事件的性别特异性影响。
使用 ATTICA（2002-2012 年，n=845 例无 CVD 受试者）和 GREECS（2004-2014 年，n=2172 例急性冠状动脉综合征（ACS）受试者）前瞻性流行病学研究的希腊样本，分别用于首次和复发性事件。抑郁症状在基线时通过 Zung 自评抑郁量表在 ATTICA 研究中进行评估，在 GREECS 研究中通过流行病学研究中心抑郁量表进行评估。
ACS 以及无 CVD 的女性在抑郁症状方面的评分明显更高。男性在首次（19.7%对 11.7%）和随后的 CVD 事件（38.8%对 32.9%）中得分均高于女性。在有抑郁症状的参与者中，男性与女性首次和复发性 CVD 事件的发生率比值低于 1，这证实了抑郁女性比抑郁男性更有可能发生 CVD 事件。多因素分析显示，抑郁症状对女性首次（危险比（HR）=2.72，95%置信区间（95%CI）1.50，9.12）和复发性（HR=1.31，95%CI 1.01，1.69）CVD 事件有独立的加重作用。女性的中介分析显示，抑郁症状导致首次 CVD 事件风险增加的 35%（23%，44%）归因于传统危险因素。复发性 CVD 事件的相应比例为 46%（23%，53%）；观察到与每个调整因素对应的中介效应的排序模式不同。
本研究进一步证实了心理应激源对 CVD 发病和进展的重要驱动作用，主要在女性中，同时也引发了对这一说法背后未知途径的研究。
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