Scared to Death? Generalized Anxiety Disorder and Cardiovascular Events in Patients With Stable Coronary Heart Disease The Heart and Soul Study

Department of Medical Psychology, Tilburg University, Warandelaan 2, 5000 LE Tilburg, the Netherlands.
Archives of general psychiatry (Impact Factor: 14.48). 07/2010; 67(7):750-8. DOI: 10.1001/archgenpsychiatry.2010.74
Source: PubMed


Anxiety is common in patients with coronary heart disease (CHD), but studies examining the effect of anxiety on cardiovascular prognosis and the role of potential mediators have yielded inconsistent results.
To evaluate the effect of generalized anxiety disorder (GAD) on subsequent cardiovascular events and the extent to which this association is explained by cardiac disease severity and potential behavioral or biological mediators.
Prospective cohort study (Heart and Soul Study).
Participants were recruited between September 11, 2000, and December 20, 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up until March 18, 2009.
One thousand fifteen outpatients with stable CHD followed up for a mean (SD) of 5.6 (1.8) years.
We determined the presence of GAD using the Diagnostic Interview Schedule. Proportional hazards models were used to evaluate the association of GAD with subsequent cardiovascular events and the extent to which this association was explained by potential confounders and mediators.
A total of 371 cardiovascular events occurred during 5711 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 9.6% in the 106 participants with GAD and 6.6% in the 909 participants without GAD (P = .03). After adjustment for demographic characteristics, comorbid conditions (including major depressive disorder), cardiac disease severity, and medication use, GAD remained associated with a 62% higher rate of cardiovascular events (hazard ratio, 1.62; 95% confidence interval, 1.11-2.37; P = .01). Additional adjustment for a variety of potential behavioral and biological mediators had little effect on this association (hazard ratio, 1.74; 95% confidence interval, 1.13-2.67; P = .01).
In outpatients with CHD, a robust association between GAD and cardiovascular events was found that could not be explained by disease severity, health behaviors, or biological mediators. How GAD leads to poor cardiovascular outcomes deserves further study.

Download full-text


Available from: Peter De Jonge
  • Source
    • "There are more studies that have found associations between anxiety and cardiac disease [9] [10] [11] [12], than have found no association [13]. There are studies finding evidence for negative outcomes among those with anxiety and a current cardiac condition [14] [15] [16], although not mortality [15] [17]. The behavioural effects of anxiety are also mixed, with evidence of anxiety leading to "
    [Show abstract] [Hide abstract]
    ABSTRACT: There has been increasing interest in the relationship between cardiac and metabolic conditions with mental illness. Many studies have found associations between these conditions and depression but results with anxiety disorders have been mixed. We explore these relationships in a nationally representative survey using physician diagnoses of physical conditions and DSM-IV psychiatric disorders. Data came from the nationally representative German Health Survey (N=4181, age 18-65). Physician diagnoses of angina, myocardial infarction, congestive heart, hypertension, dyslipidemia, diabetes, and obesity were examined in relation to depression and anxiety disorders, which were assessed through a modified version of the Composite International Diagnostic Interview. Multiple logistic regression analyses were used to examine the associations between these conditions. After adjusting for sociodemographics, psychiatric comorbidity, and substance use, having an anxiety disorder was associated with increased odds of cardiac conditions and metabolic risk factors with odds ratios ranging from 1.3 to 3.3. Depression was not associated with any of the conditions but was associated with poor medical compliance for health conditions on two outcomes measured. Anxiety was also associated with reduced medical compliance for one health behaviour measured. Anxiety disorders, but not depression, were associated with metabolic and cardiac conditions in our sample. Both conditions were related to some aspects of poor self-care for health conditions and therefore may be linked to negative outcomes. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Apr 2015 · General hospital psychiatry
  • Source
    • "The prevalence of generalised anxiety disorder in CHD is also noteworthy (13.5% current and 25% lifetime GAD) in a systematic review of 12 studies (Tully & Cosh, 2013). The salience of GAD to CHD prognosis is also evident in several prospective cohorts indicating a tendency to experience poorer cardiac outcomes (Frasure-Smith & Lespérance, 2008; Martens et al., 2010). Note that anxiety disorder detection has attracted far less research than depression to recommend suitable screening tools in CHD populations (Bunevicius et al., 2013; Frasure-Smith & Lespérance, 2008; Tully & Penninx, 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Depression prevalence is between 15% and 20% in coronary heart disease patients, such as those with angina, or after a myocardial infarction or coronary artery bypass graft surgery. The presence of depression places a coronary heart disease patient at twofold higher risk for further major cardiac events and death, as well as poor quality of life and early exit from the labour force. As a consequence, several learned societies, including the National Heart Foundation of Australia, have published guidelines that recommend questionnaire screening to improve identification and management strategies for depression in coronary heart disease patients. Psychologists in hospitals, community settings, and private practice can have a key role in the realisation of the National Heart Foundation of Australia's aims. We review the recent guidelines and outline implications for psychologists to identify and manage depression in coronary heart disease patients. The evidence reviewed suggests that cognitive-behavioural therapy and problem-solving therapy are frontline non-pharmacological interventions for depression in CHD patients.
    Full-text · Article · Nov 2014 · Australian Psychologist
  • Source
    • "The higher the number of metabolic syndrome traits, the worse impact they have on cardiac function, cardiac remodeling, and carotid artery atherosclerosis (Antonini-Canterin et al., 2014). Our result suggests one of the molecular mechanisms underlying elevated risk of cardiovascular disease in individuals with generalized anxiety disorder observed in large prospective epidemiological studies (Martens et al., 2010; Janszky et al., 2010; Roest et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Prospective epidemiological studies found that generalized anxiety disorder (GAD) can impair immune function and increase risk for cardiovascular disease or events. Mechanisms underlying the physiological reverberations of anxiety, however, are still elusive. Hence, we aimed to investigate molecular processes mediating effects of anxiety on physical health using blood gene expression profiles of 336 community participants (157 anxious and 179 control). We examined genome-wide differential gene expression in anxiety, as well as associations between nine major modules of co-regulated transcripts in blood gene expression and anxiety. No significant differential expression was observed in women, but 631 genes were differentially expressed between anxious and control men at the false discovery rate of 0.1 after controlling for age, body mass index, race, and batch effect. Gene set enrichment analysis (GSEA) revealed that genes with altered expression levels in anxious men were involved in response of various immune cells to vaccination and to acute viral and bacterial infection, and in a metabolic network affecting traits of metabolic syndrome. Further, we found one set of 260 co-regulated genes to be significantly associated with anxiety in men after controlling for the relevant covariates, and demonstrate its equivalence to a component of the stress-related conserved transcriptional response to adversity profile. Taken together, our results suggest potential molecular pathways that can explain negative effects of GAD observed in epidemiological studies. Remarkably, even mild anxiety, which most of our participants had, was associated with observable changes in immune-related gene expression levels. Our findings generate hypotheses and provide incremental insights into molecular mechanisms mediating negative physiological effects of GAD.
    Full-text · Article · Oct 2014 · Brain Behavior and Immunity
Show more