Symptoms of anxiety and depression in patients with stable coronary heart disease: prognostic value and consideration of pathogenetic links

2007 ◽  
Vol 14 (4) ◽  
pp. 547-554 ◽  
Author(s):  
Dietrich Rothenbacher ◽  
Harry Hahmann ◽  
Bernd Wüsten ◽  
Wolfgang Koenig ◽  
Hermann Brenner
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Depressive Symptoms ◽  
Hazard Ratio ◽  
Anxiety Symptoms ◽  
Anxiety And Depression ◽  
Manifest Anxiety ◽  
Cardiovascular Disease Event

Background We evaluated the association of symptoms of anxiety and depression with fatal and non-fatal cardiovascular disease events among patients with coronary heart disease and considered several potential underlying pathogenetic links. Design This was a prospective cohort study. Methods In this study, including coronary heart disease patients undergoing an in-patient rehabilitation program, symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal cardiovascular disease events were determined during a 3-year follow-up. Results Of the 1052 patients with CHD 16.1% showed a borderline and 8.3% a manifest anxiety symptoms score, whereas 11.8 and 5.9% showed a borderline and manifest depressive symptoms score, respectively. During the 3-year follow-up fatal and non-fatal cardiovascular disease events were observed in 73 (6.9%) patients. After adjustment for covariates, patients having manifest anxiety symptoms had a statistically significant hazard ratio (HR) of 2.32 [95% confidence interval (CI) 1.14-4.74] for a cardiovascular disease event, and patients with depressive symptoms had an HR of 1.47 (95% CI 0.62-3.51) compared to other patients. In a model considering anxiety and depressive symptom scores simultaneously, the hazard ratio for a cardiovascular disease event associated with anxiety symptoms increased to 3.31 (95% CI 1.32-8.27), whereas the hazard ratio associated with depressive symptoms decreased (HR 0.62; 95% CI 0.20-1.87). We found a positive association of increased anxiety scores with body mass index and systolic blood pressure. Conclusions The study suggests an important role especially for symptoms of anxiety for long-term prognosis of patients with known coronary heart disease. It furthermore suggests that several pathogenetic links may partly explain the increased risk.

scholarly journals Association of FKBP5 genotype with depressive symptoms in patients with coronary heart disease: a prospective study

2020 ◽  
Vol 127 (12) ◽  
pp. 1651-1662
Author(s):  
Julia Brandt ◽  
Katharina Warnke ◽  
Silke Jörgens ◽  
Volker Arolt ◽  
Katja Beer ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Depressive Symptoms ◽  
Coronary Revascularization ◽  
Central Element ◽  
Depression Scale ◽  
Stress System ◽  
Linear Regression Models ◽  
A Prospective Study

AbstractDepression and coronary heart disease (CHD) are prevalent and often co-occurring disorders. Both have been associated with a dysregulated stress system. As a central element of the stress system, the FKBP5 gene has been shown to be associated with depression. In a prospective design, this study aims to investigate the association of FKBP5 with depressive symptoms in CHD patients. N = 268 hospitalized CHD patients were included. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS-D) at four time points (baseline, and after 1 month, 6 months, and 12 months). The functional FKBP5 single-nucleotide polymorphism (SNP) rs1360780 was selected for genotyping. Linear regression models showed that a higher number of FKBP5 C alleles was associated with more depressive symptoms in CHD patients both at baseline (p = 0.015) and at 12-months follow-up (p = 0.025) after adjustment for confounders. Further analyses revealed that this effect was driven by an interaction of FKBP5 genotype with patients’ prior CHD course. Specifically, only in patients with a prior myocardial infarction or coronary revascularization, more depressive symptoms were associated with a higher number of C alleles (baseline: p = 0.046; 1-month: p = 0.026; 6-months: p = 0.028). Moreover, a higher number of C alleles was significantly related to a greater risk for dyslipidemia (p = .016). Our results point to a relevance of FKBP5 in the association of the two stress-related diseases depression and CHD.

Abstract P253: Proton Pump Inhibitor Use is Positively Associated with Incidence of Cardiovascular Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Elizabeth J Bell ◽  
Jennifer L St. Sauver ◽  
Veronique L Roger ◽  
Nicholas B Larson ◽  
Hongfang Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Language Processing ◽  
Proton Pump ◽  
Hazard Ratio ◽  
Time Varying ◽  
Increased Risk ◽  
The Impact

Introduction: Proton pump inhibitors (PPIs) are used by an estimated 29 million Americans. PPIs increase the levels of asymmetrical dimethylarginine, a known risk factor for cardiovascular disease (CVD). Data from a select population of patients with CVD suggest that PPI use is associated with an increased risk of stroke, heart failure, and coronary heart disease. The impact of PPI use on incident CVD is largely unknown in the general population. Hypothesis: We hypothesized that PPI users have a higher risk of incident total CVD, coronary heart disease, stroke, and heart failure compared to nonusers. To demonstrate specificity of association, we additionally hypothesized that there is not an association between use of H 2 -blockers - another commonly used class of medications with similar indications as PPIs - and CVD. Methods: We used the Rochester Epidemiology Project’s medical records-linkage system to identify all residents of Olmsted County, MN on our baseline date of January 1, 2004 (N=140217). We excluded persons who did not grant permission for their records to be used for research, were <18 years old, had a history of CVD, had missing data for any variable included in our model, or had evidence of PPI use within the previous year.We followed our final cohort (N=58175) for up to 12 years. The administrative censoring date for CVD was 1/20/2014, for coronary heart disease was 8/3/2016, for stroke was 9/9/2016, and for heart failure was 1/20/2014. Time-varying PPI ever-use was ascertained using 1) natural language processing to capture unstructured text from the electronic health record, and 2) outpatient prescriptions. An incident CVD event was defined as the first occurrence of 1) validated heart failure, 2) validated coronary heart disease, or 3) stroke, defined using diagnostic codes only. As a secondary analysis, we calculated the association between time-varying H 2 -blocker ever-use and CVD among persons not using H 2 -blockers at baseline. Results: After adjustment for age, sex, race, education, hypertension, hyperlipidemia, diabetes, and body-mass-index, PPI use was associated with an approximately 50% higher risk of CVD (hazard ratio [95% CI]: 1.51 [1.37-1.67]; 2187 CVD events), stroke (hazard ratio [95% CI]: 1.49 [1.35-1.65]; 1928 stroke events), and heart failure (hazard ratio [95% CI]: 1.56 [1.23-1.97]; 353 heart failure events) compared to nonusers. Users of PPIs had a 35% greater risk of coronary heart disease than nonusers (95% CI: 1.13-1.61; 626 coronary heart disease events). Use of H 2 -blockers was also associated with a higher risk of CVD (adjusted hazard ratio [95% CI]: 1.23 [1.08-1.41]; 2331 CVD events). Conclusions: PPI use is associated with a higher risk of CVD, coronary heart disease, stroke and heart failure. Use of a drug with no known cardiac toxicity - H 2 -blockers - was also associated with a greater risk of CVD, warranting further study.

scholarly journals Comparison of Cystatin C and Creatinine as Predictors of Cardiovascular Events in a Community-Based Elderly Population

2010 ◽  
Vol 56 (5) ◽  
pp. 799-804 ◽  
Author(s):  
John Beilby ◽  
Mark L Divitini ◽  
Matthew W Knuiman ◽  
Enrico Rossi ◽  
Joseph Hung
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Renal Function ◽  
Heart Disease ◽  
Creatinine Clearance ◽  
Cystatin C ◽  
Cardiovascular Events ◽  
Community Based ◽  
Hazard Ratios

Abstract Background: Reduced renal function is an established risk factor for cardiovascular events. We compared 3 measures of renal function—serum cystatin C, serum creatinine, and calculated creatinine clearance—as predictors of subsequent cardiovascular events in a community-based population of elderly individuals. Methods: Comprehensive cardiovascular risk factor data were available for 1410 surviving participants of previous Busselton health surveys who were ≥60 years old. Hazard ratios for risk of incident coronary heart disease and cardiovascular disease over 10 years of follow-up were derived for each baseline measure of renal function by use of Cox regression. Results: All measures of renal function were significantly related to risks of morbidity and mortality from coronary heart disease and cardiovascular disease. There were 453 incident cardiovascular disease events; and the age- and sex-adjusted hazard ratios (95% CIs) were 1.34 (1.23–1.46), 1.32 (1.20–1.45), and 1.22 (1.06–1.41) per 1-SD deterioration in cystatin C, creatinine, and creatinine clearance, respectively. All 3 measures gave approximately the same age-adjusted relative risk estimates. After further adjustment for established cardiovascular risk factors, the relative risk estimates were all reduced but remained statistically significant (P &lt; 0.05). Cystatin C was not a significant predictor for cardiovascular disease after adjustment for creatinine clearance. Conclusions: In relation to predicting risk for coronary heart disease or cardiovascular disease over a 10-year follow-up in a community-based population of elderly subjects, there was no evidence that cystatin C was a better risk predictor than creatinine or creatinine clearance.

scholarly journals Comprehensive rehabilitation of patients with coronary heart disease concurrent with anxiety and depression disorders

2010 ◽  
Vol 1 (1) ◽  
pp. 51-56
Author(s):  
A. N Repin ◽  
E. V Lebedeva ◽  
T. N Sergienko ◽  
R. S Karpov
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Depressive Disorders ◽  
Outpatient Setting ◽  
Anxiety And Depression ◽  
Depression Disorders ◽  
Comprehensive Rehabilitation ◽  
Exercise Endurance ◽  
Surgical Treatments

In cardiological inpatients, coronary heart disease (CHD) is concurrent with clinical anxiety and depression disorders in 43% of cases. Comorbidity of coronary disease and anxiety and depression disorders is more frequently encountered among women than among men (40 versus 22%) and among post-aortocoronary bypass patients. Depressive disorders substantially worsen the course of CHD due to the frequent development of myocardial infarction, low exercise endurance, and patients’ refusal to have endovascular and surgical treatments. Therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants caused a reduction in anxiety and depression disorders along with the improved clinical course of CHD, as evidenced from angina pectoris and heart failure. No serious side effects were observed during continuous SSRI use. The proposed regimen for the joint follow-up, treatment, and rehabilitation of patients by a working group of cardiologists and psychiatrists within a biopsychosocial model of rehabilitation is effective. It may be extensively used in cardiology, in the outpatient setting in particular.

scholarly journals Effect of Anxiety and Depression on Survival of Cancer Patients, a 13 Year Follow-up

2021 ◽  
Vol 6 (1) ◽  
pp. 9-13
Author(s):  
Suriati Mohamed Saini ◽  
Susan Tan Mooi Koon ◽  
Mohamad Adam Bujang ◽  
Gerard Lim Chin Chye ◽  
Shalisah Sharip ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cancer Patients ◽  
Depression Scale ◽  
Cox Proportional Hazards ◽  
Anxiety Symptoms ◽  
High Rate ◽  
Anxiety And Depression ◽  
Risk Of Death ◽  
Increased Risk

Introduction: Anxiety and depression occur at a high rate in cancer patients. However, debate remains regarding the effect of anxiety and depression on cancer survival. Objective: This study aimed to determine the effect of anxiety and depressive symptoms on the survival of cancer patients. Methods: The subjects consisted of 112 cancer patients who attended the Oncology and Radiotherapy outpatient clinic Hospital Kuala Lumpur, Malaysia, in 1999. Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) questionnaire at inception. Information on patients’ mortality status for extended 13 years follow-up (in 2011) was obtained from the National Registration Department death records. Overall survival for each anxiety and depressive symptoms scores in HADS at 13 years was calculated using Cox proportional hazards regression analysis. Results: Cancer patients experienced more anxiety (83%) compared to depressive symptoms (40.2%). The mean (S.D.) HADS scores for depressive symptoms were 9.9 (2.5), and the anxiety symptoms score was 12.6 (2.1). At 13 years, half of the patients (50.9%) had died. No significant effect of anxiety (p=0.399, 95% C.I.= 6.2-8.4) or depressive symptoms at inception (p=0.749, 95% C.I.= 5.9-8.4) towards cancer patients’ survival was found at 13 years follow-up. Conclusion: The occurrence of anxiety symptoms among cancer patients in this study was 2-folds higher than depressive symptoms. However, no significant increased risk of death was found in cancer patients with anxiety or depressive symptoms at 13 years follow-up. It may imply that as time extended, survival in cancer patients may be related to various interacting elements, and intervening health factors are of importance.

The Advisory Brought to Practice Routine Screening on Depression (and Anxiety) in Coronary Heart Disease; Consequences and Implications

2011 ◽  
Vol 10 (4) ◽  
pp. 228-233 ◽  
Author(s):  
M.L.A. Luttik ◽  
T. Jaarsma ◽  
R. Sanderman ◽  
J. Fleer
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Depressive Symptoms ◽  
Stressful Life Events ◽  
Medical Center ◽  
Heart Association ◽  
Cross Sectional Study ◽  
Routine Screening ◽  
Anxiety And Depression ◽  
Cross Sectional

Introduction: Following the evidence, the American Heart Association recently published a Science Advisory with the recommendation that patients with Coronary Heart Disease (CHD) should be screened for depressive symptoms and depression. Also the Heart Failure Guidelines recommend routine screening for depressive symptoms. Screening for anxiety was not included in these recommendations, despite findings in literature suggesting that cardiac patients are at risk for high levels of anxiety. Objective: The aim of the current study is to obtain a realistic estimation of the consequences and implications of this advice for clinical practice. Method: Data on anxiety, and depression, need for help, demographics and disease related variables were collected in a cross-sectional study within a 2-month period (July–August 2008) at the cardiac outpatient clinic of the University Medical Center Groningen (The Netherlands). Patients: Data of 217 patients were analyzed, mean age was 58 years (±16) and 62% of the respondents were male. Results: Of 217 patients, 26% indicated to have depressive symptoms and 42% indicated elevated levels of anxiety. About 35–50% of these patients indicated a moderate to high need for help. The prevalence of anxiety and depression was mainly associated with demographic factors and the occurrence of stressful life events. Conclusion: Routine screening will put an increased demand on psychosocial diagnostics and treatment, therefore the availability of professionals should be guaranteed in advance.

P3422Contrasting the risk for atherosclerotic cardiovascular disease events among individuals with lower extremity peripheral artery disease, coronary heart disease and cerebrovascular disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Hubbard ◽  
L D Colantonio ◽  
R S Rosenson ◽  
T M Brown ◽  
E A Jackson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Lower Extremity ◽  
Cerebrovascular Disease ◽  
Event Rate ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
History Of ◽  
Artery Disease

Abstract Background Having more vascular conditions, including coronary heart disease (CHD), cerebrovascular disease and lower extremity artery disease (LEAD), may increase the risk for atherosclerosis cardiovascular disease (ASCVD) events. Specific vascular conditions may increase the ASCVD event rate more than others. Purpose To compare the risk for future ASCVD events associated with the number and type of vascular conditions among adults with a history of CHD, cerebrovascular disease and/or LEAD. Methods We analyzed data from US adults ≥19 years of age with commercial or Medicare health insurance who had a history of CHD, cerebrovascular disease and/or LEAD as of December 31, 2014 (N=901,391). Individuals were followed through December 31, 2016 (median follow-up: 2 years) for ASCVD events, including myocardial infarction, coronary revascularization, stroke, carotid revascularization and lower extremity amputation or revascularization. Results Among individuals included in the current analysis (mean age 63 years, 45% female), 70%, 23% and 7% had 1, 2 and 3 vascular conditions, respectively. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratio for ASCVD among individuals with 2 and 3 versus 1 vascular conditions was 1.88 (1.85, 1.92) and 2.93 (2.86, 3.00), respectively. Among individuals with 1 vascular condition, the rate of ASCVD events per 1,000 person-years was 46.5 (95% CI 44.1, 49.0), 29.6 (95% CI 29.0, 30.1) and 19.9 (95% CI 19.2, 20.8) for those with LEAD, CHD and cerebrovascular disease, respectively. The multivariable-adjusted hazard ratio (95% CI) for ASCVD events comparing individuals with LEAD only and CHD only versus those with cerebrovascular disease only was 1.84 (1.77, 1.92) and 1.12 (1.08, 1.16), respectively. Among individuals with 2 vascular conditions, the ASCVD event rate per 1,000 person-years was higher in those with LEAD and CHD (122.0, 95% CI 112.5, 132.2) and with LEAD and cerebrovascular disease (92.4, 95% CI 79.9, 106.4), versus those with CHD and cerebrovascular disease (59.1, 95% CI 54.8, 63.6). The multivariable-adjusted hazard ratio (95% CI) comparing individuals with LEAD and CHD and those with LEAD and cerebrovascular disease versus those with CHD and cerebrovascular disease was 1.48 (1.44, 1.53) and 1.49 (1.41, 1.58), respectively. Conclusion Among adults with vascular disease, having LEAD confers a higher risk for future ASCVD events than CHD or cerebrovascular disease and this group may benefit from more intensive risk reduction treatment. Acknowledgement/Funding Amgen Inc.

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