Persistent psychological distress and mortality in patients with stable coronary artery disease

Stewart, R.; Colquhoun, David; Marschner, Simone; Kirby, Adrienne; Simes, John; Nestel, Paul J.; Glozier, Nick; O’Neil, Adrienne; Oldenburg, Brian; White, Harvey D.; Tonkin, Andrew

doi:10.1136/heartjnl-2016-311097

Cited by 60 publications

(41 citation statements)

References 38 publications

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“…In patients of cardiovascular disease, several stressors have also been strongly related to cardiovascular endpoints, such as recurrent events and mortality. [61][62][63][64] In general, strong associations are less likely to be confounded than weak associations. For example, the 4.7-fold excess risk of cardiac event during anger outburst 60 could be explained away only if an unmeasured confounder was associated with both stress and cardiac event by as large hazard ratio as 9.0; a weaker uncontrolled confounding could not do so (Figure 2).…”

Section: Scale Of the Problemmentioning

confidence: 99%

Effects of stress on the development and progression of cardiovascular disease

2017

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Cardiovascular disease remains the leading cause of disease burden globally, which underlies the continuing need to identify new complementary targets for prevention. Over the past 5-10 years, the pooling of multiple data sets into 'mega-studies' has accelerated progress in research on stress as a risk and prognostic factor for cardiovascular disease. Severe stressful experiences in childhood, such as physical abuse and household substance abuse, can damage health and increase the risk of multiple chronic conditions in adulthood. Compared with childhood stress and adulthood classic risk factors, such as smoking, high blood pressure, and high serum cholesterol levels, the harmful effects of stress in adulthood are generally less marked. However, adulthood stress has an important role as a disease trigger in individuals who already have a high atherosclerotic plaque burden, and as a determinant of prognosis and outcome in those with pre-existing cardiovascular or cerebrovascular disease. In real-life settings, mechanistic studies have corroborated earlier laboratory-based observations on stress-related pathophysiological changes that underlie triggering, such as lowered arrhythmic threshold and increased sympathetic activation with related increases in blood pressure, as well as pro-inflammatory and procoagulant responses. In some clinical guidelines, stress is already acknowledged as a target for prevention for people at high overall risk of cardiovascular disease or with established cardiovascular disease. However, few scalable, evidence-based interventions are currently available.

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Section: Scale Of the Problemmentioning

confidence: 99%

Effects of stress on the development and progression of cardiovascular disease

2017

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“…The possibility is real that CHD itself is the source of distress and a determinant of poor outcome. In fact, in the study by Stewart et al, 5 angina and dyspnoea increased progressively with the increase in the level of distress. Commonly, these symptoms are perceived as worrisome (and stressful) and as a harbinger of imminent risk (including the risk of death) in subjects experiencing them.…”

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confidence: 88%

“…The study by Stewart et al 5 found an increased risk of mortality only in subjects in the category of persistent moderate-to-high distress but not in subjects in lower distress categories. These results are not easy to reconcile with prior studies showing a dose–response relationship across all stress strata in which even low levels of stress were associated with increased risk of mortality 3.…”

mentioning

confidence: 94%

“…In their Heart publication, Stewart et al 5 investigated the association between occasional or persistent psychological distress and mortality in 950 subjects with stable CHD obtained from the Long-Term Intervention with Pravastatin in Ischemic Disease trial. All included patients completed the General Health Questionnaire-30 (GHQ-30) at least four times over a 4-year stress assessment period.…”

mentioning

confidence: 99%

“…The study by Stewart et al 5 is important for clinicians and healthcare providers. As psychological distress may be dismissed as a reaction to the diagnosis of a serious event like acute myocardial infarction, the study draws attention to screening and eventually treating psychological distress over extended time intervals in patients with stable CHD.…”

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confidence: 99%

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Psychological distress and mortality in stable coronary heart disease: persistence of high distress means increased risk

Ndrepepa

2017

Heart

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Anxiety disorder and cardiovascular disease: a two‐sample Mendelian randomization study

Peng,

Meng,

Guo

et al. 2024

ESC Heart Failure

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AimsCardiovascular disease is the leading cause of death worldwide. Anxiety disorders are common psychiatric conditions associated with cardiovascular outcomes. This two‐sample Mendelian randomization (MR) study investigated the causal relationship between anxiety disorders and coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF), and atrial fibrillation (AF).MethodsSingle nucleotide polymorphisms (SNPs) associated with anxiety disorders (16 730 cases; 101 021 controls) were obtained from the UK Biobank genome‐wide association study (GWAS). Cardiovascular outcome data were derived from the FinnGen study (CHD: 21 012 cases and 197 780 controls; MI: 12 801 cases and 187 840 controls; HF: 23 397 cases and 194 811 controls; and AF: 22 068 cases and 116 926 controls). Inverse variance weighted (IVW), MR–Egger, weighted median, simple mode, and weighted mode analyses examined causality.ResultsIVW analysis demonstrated significant causal relationships between anxiety disorders and increased risk of CHD [odds ratio (OR): 4.496; 95% confidence interval (CI): 1.777–11.378; P = 0.002], MI (OR: 5.042; 95% CI: 1.451–17.518; P = 0.011), and HF (OR: 3.255; 95% CI: 1.461–7.252; P = 0.004). No relationship was observed with AF (OR: 1.775; 95% CI: 0.612–5.146; P = 0.29). Other methods showed non‐significant associations. Two‐way analysis indicated no reverse causality.ConclusionsAnxiety disorders were causally associated with greater risk of CHD, MI, and HF but not AF among individuals of European descent. Further research on mediating mechanisms and in diverse populations is warranted.

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Persistent psychological distress and mortality in patients with stable coronary artery disease

Abstract: In patients with stable coronary artery disease, persistent psychological distress of at least moderate severity is associated with a substantial increase in CV and all-cause mortality.

Cited by 60 publications

References 38 publications

Effects of stress on the development and progression of cardiovascular disease

Effects of stress on the development and progression of cardiovascular disease

Psychological distress and mortality in stable coronary heart disease: persistence of high distress means increased risk

Anxiety disorder and cardiovascular disease: a two‐sample Mendelian randomization study

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