Depression and Anxiety as Predictors of 2-Year Cardiac Events in Patients With Stable Coronary Artery Disease

Department of Psychiatry and School of Nursing, McGill University, Montreal, Quebec, Canada.
Archives of general psychiatry (Impact Factor: 14.48). 01/2008; 65(1):62-71. DOI: 10.1001/archgenpsychiatry.2007.4
Source: PubMed


Anxiety and depression are associated with mechanisms that promote atherosclerosis. Most recent studies of emotional disturbances in coronary artery disease (CAD) have focused on depression only.
To assess the 2-year cardiac prognostic importance of the DSM-IV-based diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) and self-report measures of anxiety and depression and their co-occurrence.
Two-year follow-up of 804 patients with stable CAD (649 men) assessed using the Beck Depression Inventory II (BDI-II), the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the Structured Clinical Interview for DSM-IV (masked to self-reports) 2 months after acute coronary syndromes.
Major adverse cardiac events (MACEs) (cardiac death, myocardial infarction, cardiac arrest, or nonelective revascularization) in the 2 years after baseline.
Of the 804 patients, 57 (7.1%) met the criteria for MDD and 43 (5.3%) for GAD (11 [1.4%] had comorbidity); 220 (27.4%) had elevated BDI-II scores (> or = 14), and 333 (41.4%) had elevated HADS-A scores (> or = 8), with 21.1% overlap. MDD (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.62-5.01), GAD (OR, 2.09; 95% CI, 1.08-4.05), elevated BDI-II (OR, 1.75; 95% CI, 1.21-2.54), elevated HADS-A score (OR, 1.67; 95% CI, 1.18-2.37), and continuous standardized scores on the BDI-II (OR, 1.34; 95% CI, 1.11-1.62) and the HADS-A (OR, 1.38; 95% CI, 1.16-1.63) all predicted MACEs. After covariate control, only the P value associated with the continuous BDI-II score increased to above .10. Most of the risk associated with elevated symptoms was in patients with psychiatric disorders. However, patients with comorbid MDD and GAD or elevated anxiety and depression symptoms were not at greater MACE risk than those with only 1 factor.
Anxiety and depression predict greater MACE risk in patients with stable CAD, supporting future research into common genetic, environmental, and pathophysiologic pathways and treatments.

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    • "Anxiety and depressive symptoms are prevalent in patients with major cardiac events [7]. Although premorbid anxiety and depressive disorders predispose patients to coronary diseases [10], the emergence of new onset depression and anxiety after myocardial infarction or CABG is also associated with a poor outcome [9,23] . Despite the fact that the complex pathophysiological interactions between mental disorders and coronary diseases are not well understood [12,24], the evidence confirms the beneficial effects of therapy for psychiatric disorders on prognosis of cardiac diseases and quality of life [6,25]. "
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    ABSTRACT: To investigate the role of cardiac rehabilitation program in depression and anxiety levels after coronary artery bypass graft surgery. Depression and anxiety are associated with worse outcome after coronary artery bypass graft surgery.
    Full-text · Article · Feb 2016 · Cor et vasa
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    • "The available data about medications and psychiatric comorbidity were scant and heterogeneous. Since other psychiatric disorders have been associated with cardiac risk (Smith and Lesperance, 2008), and different medications might increase the occurrence of certain CDs (Frommeyer and Eckardt, 2015), the lack of examination or adjustment for these factors did not allow to understand if they contribute to the association between PD and CDs. Finally, the link between PD and cardiac diseases other than CAD has, to date, been insufficiently investigated. "
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    ABSTRACT: Background: The recognized relationship between panic disorder (PD) and cardiac disorders (CDs) is not unequivocal. We reviewed the association between PD and coronary artery disease (CAD), arrhythmias, cardiomyopathies, and sudden cardiac death. Methods: We undertook an updated systematic review, according to PRISMA guidelines. Relevant studies dating from January 1, 2000, to December 31, 2014, were identified using the PubMed database and a review of bibliographies. The psychiatric and cardiac diagnostic methodology used in each study was then to very selective inclusion criteria. Results: Of 3044 studies, 14 on CAD, 2 on cardiomyopathies, and 1 on arrhythmias were included. Overall, the studies supported a panic-CAD association. Furthermore, in some of the studies finding no association between current full-blown PD and CAD, a broader susceptibility to panic, manifesting as past PD, current agoraphobia, or subthreshold panic symptoms, appeared to be relevant to the development of CAD. Preliminary data indicated associations between panic, arrhythmias, and cardiomyopathies. Limitations: The studies were largely cross-sectional and conducted in cardiological settings. Only a few included blind settings. The clinical conditions of patients with CDs and the qualifications of raters of psychiatric diagnoses were highly heterogeneous. CDs other than CAD had been insufficiently investigated. Conclusions: Our review supported a relationship between PD and CDs. Given the available findings and the involvement of the cardiorespiratory system in the pathophysiology of PD, an in-depth investigation into the panic-CDs association is highly recommended. This should contribute to improved treatment and prevention of cardiac events and/or mortality, linked to PD.
    Full-text · Article · Jan 2016 · Journal of Affective Disorders
    • "Since Type D personality has been proposed as a prognostic factor in CAD (Denollet & Pedersen, 2008;Denollet et al., 2013), clinicians should bear in mind that, when using the DS14, it could reflect a state depressive component instead. Because of contrasting results on the prognostic validity of Type D (Grande, Romppel & Barth, 2012;Meyer, Hussein, Lange & Herrmann-Lingen, 2014) and depression (Smith & Lesp erance, 2008) on cardiac outcome, further studies, specifically aimed at disentangling this issue, are needed. Table 3. Temporal stability of DS14 in the sample T0-T2 T2-T12 "
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    ABSTRACT: It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three-hundred-and-four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re-evaluated at 1, 2, 4, 6, 9 and 12-month follow-ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS-D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co-vary with HADS-D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd.
    No preview · Article · Sep 2015 · Scandinavian Journal of Psychology
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