Psychosocial Modulators of Angina Response to Myocardial Ischemia

Abstract

Background-Although angina is often caused by atherosclerotic obstruction of the coronary arteries, patients with similar amounts of myocardial ischemia may vary widely in their symptoms. We sought to compare clinical and psychosocial characteristics associated with more frequent angina after adjusting for the amount of inducible ischemia. Methods and Results-From 2004 to 2006, 788 consecutive patients undergoing single-photon emission computed tomography stress perfusion imaging at 2 Seattle hospitals were assessed for their frequency of angina over the previous 4 weeks with the Seattle Angina Questionnaire and for a broad range of psychosocial characteristics. Among patients with demonstrable ischemia on single-photon emission computed tomography (summed difference score Ն2; nϭ191), angina frequency was categorized as none (Seattle Angina Questionnaire scoreϭ100; nϭ68), monthly (scoreϭ61 to 99; nϭ66), and weekly or daily (scoreϭ0 to 60; nϭ57). Using multivariable ordinal logistic regression, increasing angina was significantly associated with a history of coronary revascularization (odds ratio 2.24, 95% confidence interval 1.19 to 4.19), anxiety (odds ratio 4.72, 95% confidence interval 1.91 to 11.66), and depression (odds ratio 3.12, 95% confidence interval 1.45 to 6.69) after adjustment for the amount of inducible ischemia. Conclusions-Among patients with a similar burden of inducible ischemia, a history of coronary revascularization and current anxiety and depressive symptoms were associated with more frequent angina. These results support the study of angina treatment strategies that aim to reduce psychosocial distress in conjunction with efforts to lessen myocardial ischemia. (Circulation. 2009;120:126-133.)

There is No Association Between the Omega-3 Index and Depressive Symptoms in Patients With Heart Disease Who Are Low Fish Consumers

“…Nevertheless, despite the low ratings of depression, we found that worse angina status was associated with higher depression scores. These findings are consistent with previous studies which have reported that patients with higher depression scores (measured by CES-D) suffered more frequent angina (measured by SAQ) [5]. However, there were no associations between angina status and the Omega-3 Index.…”

“…Also, as a major manifestation of coronary heart disease (CHD), angina may be one of the possible mediators in the relationship between CHD and depression. Depression can augment perceived pain [4] thus the sensation of angina may be increased in patients with depression [5].…”

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

“…Among patients with a similar burden of inducible ischemia, current anxiety and depressive symptoms are associated with more frequent angina. 73 Similar findings are present among patients who have experienced an acute coronary syndrome. 74,75 Among patients with heart failure, the prevalence of depression is even higher (eg, 30% to 35%).…”

Religion, spirituality and cardiovascular disease: research, clinical implications, and opportunities in Brazil

“…High emotional stress, loneliness, and social isolation are associated with atrial and ventricular arrhythmias [66], left ventricular dysfunction, myocardial ischemia [67], recurrent myocardial infarction [68], and increased risk of cardiac death [69], as well as other cardiac abnormalities. Likewise, personality traits such as cynical hostility [70], and emotional states such as depression [71] and anxiety [72], are linked to increased risk of CVD and worse prognosis. Lower risk, however, has been found for optimism, [73] agreeableness, 74 and other positive emotions [75].…”