Scared to Death? Generalized Anxiety Disorder and Cardiovascular Events in Patients With Stable Coronary Heart Disease

Martens, Elisabeth J.; Jonge, Peter de; Na, Beeya; Cohen, Beth E.; Lett, Heather S.; Whooley, Mary A.

doi:10.1001/archgenpsychiatry.2010.74

Cited by 216 publications

(160 citation statements)

References 73 publications

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“…This would have important implications for interventional strategies. We found that anxiety was associated with increased risk of CVD, which is consistent with previous findings suggesting that both anxiety and depression are relevant to cardiac outcomes (Roest et al, 2010;Martens et al, 2010). However, in contrast to our hypothesis, we found that participants with depression and co-morbid anxiety were not at increased risk compared to those with depression alone.…”

Section: Discussionsupporting

confidence: 88%

Depression, anxiety and cardiovascular disease: Which symptoms are associated with increased risk in community dwelling older adults?

Gallagher

O’Regan

Cronin

et al. 2012

Journal of Affective Disorders

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a b s t r a c tBackground: Depression is a risk factor for Cardiovascular Disease (CVD). It has been reported that somatic symptoms of depression and not cognitive symptoms are associated with increased risk although findings have been inconsistent. Few studies have examined whether co-morbid anxiety confers additive risk. Methods: We conducted a cross sectional analysis of 7872 community dwelling adults aged 50 years and over from The Irish LongituDinal Study on Ageing (TILDA). Depressive and anxiety symptoms were assessed with Center for Epidemiologic Studies Depression (CES-D) scale and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), respectively. We conducted logistic regression analyses to determine the relationship between depression, anxiety, individual depressive symptoms and CVD. We further determined whether co-morbid anxiety was associated with increased risk. Results: Seven hundred and thirty eight (9.4%) study participants reported clinically significant depression. Depression was associated with 80% increased risk of CVD following adjustment for cardiovascular risk factors. Individual depressive symptoms most consistently associated with CVD included low mood, sadness, amotivation, fatigue, diminished appetite and concentration difficulties. Anxiety was associated with increased risk of CVD but did not confer additive risk in participants with depression. Limitations: Cross sectional design. Conclusion: Core symptoms of depression, which are both cognitive and somatic in nature, are associated with increased risk of CVD while co-morbid anxiety did not confer additive risk. It is important that clinicians give due regard both to both cognitive and somatic symptoms of depression when determining cardiovascular risk. Future longitudinal investigation should confirm these findings and explore potential pathological mechanisms.

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Section: Discussionsupporting

confidence: 88%

Depression, anxiety and cardiovascular disease: Which symptoms are associated with increased risk in community dwelling older adults?

Gallagher

O’Regan

Cronin

et al. 2012

Journal of Affective Disorders

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“…[38][39][40][41][42] Anxiety and depression have been associated with increased risk of cardiovascular disease and are common in those with established cardiovascular disease; their added presence in established cardiovascular disease confers a poorer prognosis. 40,41,[43][44][45][46][47][48] There is a growing body of research which describes the mechanisms of mind-heart interactions. The autonomic nervous system is one of the principal components of the mindheart connection and is one of the fundamental links between thoughts and emotions and the heart.…”

mentioning

confidence: 99%

Meditation: Should a cardiologist care?

Olex

Newberg

Figueredo

2013

International Journal of Cardiology

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“…Anxiety itself increases the risk for CAD [101] and manifest CAD increases the risk of anxiety [102]. Anxiety can also be experienced in situations representing earlier trauma in life, for example being locked in.…”

Section: Anxietymentioning

confidence: 99%

Magnetic Resonance Imaging of the Heart : Image quality, measurement accuracy and patient experience

Ahlander¹

2016

Linköping University Medical Dissertations

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Background: Non-invasive diagnostic imaging of atherosclerotic coronary artery disease (CAD) is frequently carried out with cardiovascular magnetic resonance imaging (CMR) or myocardial perfusion single photon emission computed tomography (MPS). CMR is the gold standard for the evaluation of scar after myocardial infarction and MPS the clinical gold standard for ischemia. Magnetic Resonance Imaging (MRI) is at times difficult for patients and may induce anxiety while patient experience of MPS is largely unknown. Aims: To evaluate image quality in CMR with respect to the sequences employed, the influence of atrial fibrillation, myocardial perfusion and the impact of patient information. Further, to study patient experience in relation to MRI with the goal of improving the care of these patients. Method: Four study designs have been used. In paper I, experimental cross-over, paper (II) experimental controlled clinical trial, paper (III) psychometric crosssectional study and paper (IV) prospective intervention study. A total of 475 patients ≥ 18 years with primarily cardiac problems (I-IV) except for those referred for MRI of the spine (III) were included in the four studies. Result: In patients (n=20) with atrial fibrillation, a single shot steady state free precession (SS-SSFP) sequence showed significantly better image quality than the standard segmented inversion recovery fast gradient echo (IR-FGRE) sequence (I). In first-pass perfusion imaging the gradient echo-echo planar imaging sequence (GREEPI) (n=30) had lower signal-to-noise and contrast–to-noise ratios than the steady state free precession sequence (SSFP) (n=30) but displayed a higher correlation with the MPS results, evaluated both qualitatively and quantitatively (II). The MRIAnxiety Questionnaire (MRI-AQ) was validated on patients, referred for MRI of either the spine (n=193) or the heart (n=54). The final instrument had 15 items divided in two factors regarding Anxiety and Relaxation. The instrument was found to have satisfactory psychometric properties (III). Patients who prior CMR viewed an information video scored significantly (lower) better in the factor Relaxation, than those who received standard information. Patients who underwent MPS scored lower on both factors, Anxiety and Relaxation. The extra video information had no effect on CMR image quality (IV). Conclusion: Single shot imaging in atrial fibrillation produced images with less artefact than a segmented sequence. In first-pass perfusion imaging, the sequence GRE-EPI was superior to SSFP. A questionnaire depicting anxiety during MRI showed that video information prior to imaging helped patients relax but did not result in an improvement in image quality

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Scared to Death? Generalized Anxiety Disorder and Cardiovascular Events in Patients With Stable Coronary Heart Disease

Abstract: In outpatients with CHD, a robust association between GAD and cardiovascular events was found that could not be explained by disease severity, health behaviors, or biological mediators. How GAD leads to poor cardiovascular outcomes deserves further study.

Cited by 216 publications

References 73 publications

Depression, anxiety and cardiovascular disease: Which symptoms are associated with increased risk in community dwelling older adults?

Depression, anxiety and cardiovascular disease: Which symptoms are associated with increased risk in community dwelling older adults?

Meditation: Should a cardiologist care?

Magnetic Resonance Imaging of the Heart : Image quality, measurement accuracy and patient experience

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