■先前的研究未完全评估心脏代谢危险因素(CVDRF)(高血压,高脂血症,和糖尿病)介导焦虑和抑郁(焦虑/抑郁)与心血管疾病(CVD)之间的关联。
■作者旨在评估以下内容:1)焦虑/抑郁与CVDRF事件之间的关联,以及这种关联是否介导CVD风险的增加;2)是否可能涉及神经免疫机制以及年龄和性别影响。
■使用回顾性队列设计,对MassGeneralBrighamBiobank受试者进行了10年的随访。焦虑/抑郁的存在和时间,CVDRF,和CVD使用ICD代码确定。与应激相关的神经活动,慢性炎症,通过评估杏仁核与皮质活动比来测量自主神经功能,高敏CRP,和心率变异性。采用多元回归和中介分析。
■在71,214名受试者中(平均年龄49.6岁;55.3%为女性),27,048(38.0%)在随访期间出现CVDRF。预先存在的焦虑/抑郁与CVDRF事件风险增加相关(OR:1.71[95%CI:1.59-1.83],P<0.001),并且其发育时间较短(β=-0.486[95%CI:-0.62至-0.35],P<0.001)。CVDRF的发展介导了焦虑/抑郁与CVD事件之间的关联(对数赔率:0.044[95%CI:0.034-0.055],P<0.05)。神经免疫途径促进了CVDRF的发展(每个P<0.05),并注意到显着的年龄和性别影响:年轻女性在焦虑/抑郁后经历了CVDRF的发展最大的加速。
■焦虑/抑郁加速了CVDRF的发展。这种关联在年轻女性中似乎最为明显,可能是由压力相关的神经免疫途径介导的。需要评估针对焦虑/抑郁症患者的量身定制的预防措施,以降低CVD风险。
UNASSIGNED: Prior studies have incompletely assessed whether the development of cardiometabolic risk factors (CVDRF) (hypertension, hyperlipidemia, and diabetes mellitus) mediates the association between anxiety and depression (anxiety/depression) and cardiovascular disease (CVD).
UNASSIGNED: The authors aimed to evaluate the following: 1) the association between anxiety/depression and incident CVDRFs and whether this association mediates the increased CVD risk; and 2) whether neuro-immune mechanisms and age and sex effects may be involved.
UNASSIGNED: Using a retrospective cohort design, Mass General Brigham Biobank subjects were followed for 10 years. Presence and timing of anxiety/depression, CVDRFs, and CVD were determined using ICD codes. Stress-related neural activity, chronic inflammation, and autonomic function were measured by the assessment of amygdalar-to-cortical activity ratio, high-sensitivity CRP, and heart rate variability. Multivariable regression and mediation analyses were employed.
UNASSIGNED: Among 71,214 subjects (median age 49.6 years; 55.3% female), 27,048 (38.0%) developed CVDRFs during follow-up. Pre-existing anxiety/depression associated with increased risk of incident CVDRF (OR: 1.71 [95% CI: 1.59-1.83], P < 0.001) and with a shorter time to their development (β = -0.486 [95% CI: -0.62 to -0.35], P < 0.001). The development of CVDRFs mediated the association between anxiety/depression and CVD events (log-odds: 0.044 [95% CI: 0.034-0.055], P < 0.05). Neuro-immune pathways contributed to the development of CVDRFs (P < 0.05 each) and significant age and sex effects were noted: younger women experienced the greatest acceleration in the development of CVDRFs after anxiety/depression.
UNASSIGNED: Anxiety/depression accelerate the development of CVDRFs. This association appears to be most notable among younger women and may be mediated by stress-related neuro-immune pathways. Evaluations of tailored preventive measures for individuals with anxiety/depression are needed to reduce CVD risk.