冠心病与精神心理疾病的相关性与研究现状

The correlation and research status of coronary heart disease and psychiatric disorders:a literature review

《中国心血管健康与疾病报告2022概要》报道,我国冠心病据推测患病人数1139万人,而且还呈现上升趋势。心理因素如焦虑、抑郁等与心脏健康密切相关,急性冠状动脉综合征(ACS)合并焦虑或抑郁的患者1年内非致死性心肌梗死和再住院风险分别增加约2倍和5倍,冠心病患者合并焦虑抑郁的概率最高≥80%,心理疾病对冠心病等心血管疾病的发展和预后产生重要影响,两者共病是影响我国居民健康的重大公共卫生问题。本文回顾了心理心脏病学的历史及中国心理心脏病学的发展,从双心医学的提出到相关专家共识的发布,强调了心理因素在中国心血管疾病防治中的地位和作用。结合最新研究对心理心脏病学的研究现状进行了梳理,涉及风险因素评估、遗传及生物学指标、疾病识别与筛查、药物治疗以及跨学科合作等方面的内容,对证据相对充分的干预方式进行介绍,同时涉及西医、中医及中西医结合。针对现有研究的矛盾及局限性进行分析,并对心理心脏病学的未来研究方向提出设想。倡导建立全生命周期管理理念,调查心理心脏健康的早期决定因素,以及不同生命阶段干预的影响,着眼于发展个性化的心理心脏病学方法,将基因、环境和心理社会因素融合起来,为个体患者定制预防和治疗策略,探寻心血管疾病预防和治疗更有效的策略。

Summary of the 2022 Report on Cardiovascular Health and Diseases in China:It is estimated that there are 11.39 million cases of coronary heart disease(CHD)in China,and the number is on the rise.Psychological factors such as anxiety and depression are closely related to heart health.Patients with acute coronary syndrome(ACS)combined with anxiety or depression have a risk of non-fatal myocardial infarction and rehospitalization within one year which is approximately doubled and quintupled,respectively.The probability of CHD patients having comorbid anxiety and depression is highest at over 80%.Psychological disorders have a significant impact on the development and prognosis of cardiovascular diseases such as CHD,and comorbidity between the two is a major public health issue affecting the health of Chinese residents.This article reviews the history of psychocardiology and the development of psychocardiology in China,from the proposal of bidirectional medicine to the publication of relevant expert consensus,emphasizing the status and role of psychological factors in the prevention and treatment of cardiovascular diseases in China.It provides an overview of the current research status of psychocardiology,covering aspects such as risk factor assessment,genetic and biological indicators,disease identification and screening,drug therapy,and interdisciplinary collaboration.It introduces evidence-based intervention methods and discusses both Western medicine,traditional Chinese medicine,and integrated approaches.Analyzing the contradictions and limitations of existing research,it proposes directions for future research in psychocardiology.It advocates for the establishment of a lifecycle management concept,investigation of early determinants of psychocardiac health,examination of the impact of interventions at different stages of life,and the development of personalized psychocardiology methods that integrate genetics,environment,and psychosocial factors.This aims to tailor prevention and treatment strategies to individual patients and explore more effective strategies for the prevention and treatment of cardiovascular diseases.