Depression and chest pain in patients with coronary artery disease

Abstract

Background Depression is common in patients with coronary artery disease (CAD) and is associated with more frequent chest pain. It is however unclear whether this is due to differences in underlying CAD severity. We sought to determine [1] whether depressive symptoms are associated with chest pain independently of CAD severity, [2] whether improvement in depressive symptoms over time is associated with improvement in chest pain and [3] whether the impact of revascularization on chest pain differs between patients with and without depression. Methods and results 5158 patients (mean age 63 ± 12 years, 65% male, 20% African American) undergoing cardiac catheterization completed the Seattle Angina Questionnaire (SAQ) and Patient Health Questionnaire-8 (PHQ-8) to assess angina severity and screen for depression, respectively, both at baseline and between 6 and 24 months of follow-up. We found significant correlations between PHQ-8 scores and angina frequency (SAQ-AF, r = −0.28), physical limitation (SAQ-PL, r = −0.32) and disease perception (SAQ-DS r = −0.37, all P < 0.001), which remained significant after adjustment for clinical characteristics, CAD severity, and antidepressant use. Improvement in depressive symptoms at follow-up was associated with improvement in angina subscales (SAQ-AF β 1.34, P < 0.001), SAQ-PL β 1.85, P < 0.001), and SAQ-DS (β 2.12, P < 0.001), independently of CAD severity or revascularization. Patients with depression who underwent revascularization had less improvement in chest pain frequency than those without depressive symptoms. Conclusions Depression is associated with angina, independently of CAD severity. Patients with depression may not derive as adequate symptomatic benefit from revascularization as those without. Whether treatment of underlying depression improves chest pain needs to be further studied.

Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs

“…However, reporting of chest pain was strongly associated with being in all the symptomatic groups, save the 'improving' class. This reflects a recent finding which identifies a strong association between depression and angina independent of cardiac severity [23]. Our data show that only a minority of individuals with symptoms of anxiety and depression received any specific interventions , which may be due to underreporting of symptoms by the patients themselves, and perhaps to subthreshold symptoms not meeting diagnostic criteria that encourages the GP to suggest treatment.…”

Depression, obstructive sleep apnea and psychosocial health

“…44 Depression is a major risk factor of angina, and depressive patients can show a poor prognosis even after revascularization surgery if the depression is not treated. 45 There is a release of inflammatory markers both in depression and CAD. These inflammatory makers are IL-1, IL-2, IL-4, IL-6, IL-10, TNF-α.…”

Koroner Arter Hastalarinda Ağri, Di̇spne Ve Ki̇nezyofobi̇ni̇n Yaşam Kali̇tesi̇ Üzeri̇ne Etki̇si̇

“…Hayek ve ark. KAH'Iı hastalarla yaptıkları çalışmada, göğüs ağrısının sıklıkla depresyon bulguları ile birlikte görüldüğünü, hastalık şiddetinden bağımsız bir şekilde anjina bulgusu olan hastalarda depresyonun daha fazla görüldüğünü, anjina frekansı ile fiziksel limitasyon ve hastalık algısı arasında önemli bir ilişki olduğunu gözlemlemişlerdir (13).…”

“…Hayek ve ark. yaptıkları bir başka çalışmada ise KAH'lı hastalarda göğüs ağrısının hastalık şiddetinden bağımsız bir şekilde hastalarda ciddi derecede depresyona neden olduğunu ve bireyin emosyonel durumunu olumsuz etkilediğini belirtmektedir (13). Benzer şekilde, özellikle kronik yorgunluğu olan bireylerde yorgunluğun da kinezyofobiye ve aktivite/katılım kısıtlılıklarına neden olduğu gözlenmiştir (18).…”