Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries.

Autor:	Rajan S; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, United Kingdom.; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada., McKee M; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, United Kingdom., Rangarajan S; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada., Bangdiwala S; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada., Rosengren A; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Sweden., Gupta R; Eternal Heart Care Centre & Research Institute, Jaipur, India., Kutty VR; Health Action by People, Trivandrum, India., Wielgosz A; Department of Medicine, University of Ottawa, Ontario, Canada., Lear S; Faculty of Health Sciences, Simon Fraser University, Burnaby, Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada., AlHabib KF; Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia., Co HU; University of the Philippines College of Medicine, Manila, Philippines., Lopez-Jaramillo P; Masira Research Institute, Medical School, Universidad de Santander (UDES), FOSCAL, Bucaramanga, Colombia., Avezum A; Department of Medicine, Universidade de Santo Amaro, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil., Seron P; Universidad de La Frontera, Temuco, Chile., Oguz A; Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey., Kruger IM; Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa., Diaz R; Estudios Clínicos Latinoamérica (ECLA), Rosario, Santa Fe, Argentina., Nafiza MN; Faculty of Medicine, UiTM, Malaysia., Chifamba J; University of Zimbabwe College of Health Sciences, Department of Physiology, Harare, Zimbabwe., Yeates K; Department of Medicine, Queen's University, Kingston, Ontario, Canada., Kelishadi R; Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran., Sharief WM; Department of Medicine, Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates., Szuba A; Department of Angiology, Wroclaw Medical University, Poland., Khatib R; Advocate Research Institute, Advocate Health Care, Downers Grove, Illinois.; Institute for Community and Public Health, Birzeit University, Birzeit, Palestine., Rahman O; Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan., Iqbal R; Independent University, Bangladesh, Dhaka, Bangladesh., Bo H; National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China., Yibing Z; National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China., Wei L; National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China., Yusuf S; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	JAMA psychiatry [JAMA Psychiatry] 2020 Oct 01; Vol. 77 (10), pp. 1052-1063.
DOI:	10.1001/jamapsychiatry.2020.1351
Abstrakt:	Importance: Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. Objective: To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. Design, Setting, and Participants: This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. Exposures: Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. Main Outcomes and Measures: Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. Results: Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). Conclusions and Relevance: In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.
Databáze:	MEDLINE
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