This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (26)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Anxiety Disorders  • Depression  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Nancy Frasure-Smith, PhD; François Lespérance, MD

Arch Gen Psychiatry. 2008;65(1):62-71.

Context  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.

Objective  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.

Design, Setting, and Patients  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.

Main Outcome Measures  Major adverse cardiac events (MACEs) (cardiac death, myocardial infarction, cardiac arrest, or nonelective revascularization) in the 2 years after baseline.

Results  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 (14), and 333 (41.4%) had elevated HADS-A scores (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.

Conclusion  Anxiety and depression predict greater MACE risk in patients with stable CAD, supporting future research into common genetic, environmental, and pathophysiologic pathways and treatments.

Author Affiliations: Department of Psychiatry and School of Nursing, McGill University (Dr Frasure-Smith); Montreal Heart Institute Research Center (Drs Frasure-Smith and Lespérance); Centre Hospitalier de l’Université de Montréal Research Center (Drs Frasure-Smith and Lespérance); and Department of Psychiatry, University of Montreal (Drs Frasure-Smith and Lespérance), Montreal, Quebec, Canada.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Lower-leg symptoms in peripheral arterial disease are associated with anxiety, depression, and anhedonia
Smolderen et al.
Vasc Med 2009;14:297-304.
ABSTRACT  

Elevated Depression Symptoms Predict Long-Term Cardiovascular Mortality in Patients With Atrial Fibrillation and Heart Failure
Frasure-Smith et al.
Circulation 2009;120:134-140.
ABSTRACT | FULL TEXT  

Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association
Lichtman et al.
Focus 2009;7:406-413.
ABSTRACT | FULL TEXT  

Association between Anxiety Disorders and Heart Rate Variability in The Netherlands Study of Depression and Anxiety (NESDA)
Licht et al.
Psychosom. Med. 2009;71:508-518.
ABSTRACT | FULL TEXT  

Anger, depression, and anxiety in cardiac patients: the complexity of individual differences in psychological risk.
Denollet and Pedersen
J Am Coll Cardiol 2009;53:947-949.
FULL TEXT  

Depression and heart disease: What do we know, and where are we headed?
POZUELO et al.
Cleveland Clinic Journal of Medicine 2009;76:59-70.
ABSTRACT | FULL TEXT  

CHAPTER 35 Psychological Factors and Heart Disease
Pedersen et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

Depression Screening and Patient Outcomes in Cardiovascular Care: A Systematic Review
Thombs et al.
JAMA 2008;300:2161-2171.
ABSTRACT | FULL TEXT  

Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association
Lichtman et al.
Circulation 2008;118:1768-1775.
ABSTRACT | FULL TEXT  

Depression, Anxiety, and Trait Negative Affect as Predictors of Cardiac Events: Ten Years After
Denollet
Psychosom. Med. 2008;70:949-951.
FULL TEXT  

Heterogeneity of Patients With Coronary Artery Disease and Distress and the Need to Identify Relevant Subtypes
de Jonge and Ormel
Arch Gen Psychiatry 2008;65:851-852.
FULL TEXT