- 作者：Siqin Ye ; MD<sup>?sup><sup> ; sup><sup>sy2357@columbia.edusup> ; Paul Muntner ; PhD<sup>&dagger ; sup> ; Daichi Shimbo ; MD<sup>?sup> ; Suzanne E. Judd ; PhD<sup>&dagger ; sup> ; Joshua Richman ; MD ; PhD<sup>&dagger ; sup> ; Karina W. Davidson ; PhD<sup>?sup> ; Monika M. Safford ; MD<sup>&Dagger ; sup>
- 关键词：death ; depression ; myocardial infarction ; physical exercise ; smoking
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：12 February, 2013
- 年：2013
- 卷：61
- 期：6
- 页码：622-630
- 全文大小：632 K
ss=""h4"">Objectives
The aim of this study was to determine whether behavioral mechanisms explain the association between depressive symptoms and myocardial infarction (MI) or death in individuals with coronary heart disease (CHD).ss=""h4"">Background
Depressive symptoms are associated with increased morbidity and mortality in individuals with CHD, but it is unclear how much behavioral mechanisms contribute to this association.
ss=""h4"">Methods
The study included 4,676 participants with a history of CHD. Elevated depressive symptoms were defined as scores ¡Ý4 on the Center for Epidemiologic Studies Depression 4-item Scale. The primary outcome was definite/probable MI or death from any cause. Incremental proportional hazards models were constructed by adding demographic data, comorbidities, and medications and then 4 behavioral mechanisms (alcohol use, smoking, physical inactivity, and medication non-adherence).
ss=""h4"">Results
At baseline, 638 (13.6 % ) participants had elevated depressive symptoms. Over a median 3.8 years of follow up, 125 of 638 (19.6 % ) participants with and 657 of 4,038 (16.3 % ) without elevated depressive symptoms had events. Higher risk of MI or death was observed for elevated depressive symptoms after adjusting for demographic data (hazard ratio [HR]: 1.41, 95 % confidence interval [CI]: 1.15 to 1.72) but was no longer significant after adjusting for behavioral mechanisms (HR: 1.14, 95 % CI: 0.93 to 1.40). The 4 behavioral mechanisms together significantly attenuated the risk for MI or death conveyed by elevated depressive symptoms (?36.9 % , 95 % CI: ?18.9 to ?119.1 % ), with smoking (?17.6 % , 95 % CI: ?6.5 % to ?56.0 % ) and physical inactivity (?21.0 % , 95 % CI: ?9.7 % to ?61.1 % ) having the biggest explanatory roles.
ss=""h4"">Conclusions
Our findings suggest potential roles for behavioral interventions targeting smoking and physical inactivity in patients with CHD and comorbid depression.