Browsing by Author "Watkins, Lana L"

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    Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease.
    (J Am Heart Assoc, 2013-03-19) Watkins, Lana L; Koch, Gary G; Sherwood, Andrew; Blumenthal, James A; Davidson, Jonathan RT; O'Connor, Christopher; Sketch, Michael H
    BACKGROUND: Depression has been related to mortality in coronary heart disease (CHD) patients, but few studies have evaluated the role of anxiety or the role of the co-occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD. METHODS AND RESULTS: The cohort was composed of 934 men and women with confirmed CHD (mean age, 62±11 years) who completed the Hospital Anxiety and Depression scale (HADS) during hospitalization for coronary angiography. Over the 3-year follow-up period, there were 133 deaths. Elevated scores on the HADS anxiety subscale (HADS-A≥8) were associated with increased risk of mortality after accounting for established risk factors including age, congestive heart failure, left ventricular ejection fraction, 3-vessel disease, and renal disease (hazard ratio [HR], 2.27; 95% CI, 1.55 to 3.33; P<0.001). Elevated scores on the HADS depression subscale (HADS-D≥8) were also associated with increased risk of mortality (HR, 2.18; 95% CI, 1.47 to 3.22; P<0.001). When both psychosocial factors were included in the model, each maintained an association with mortality (anxiety, HR, 1.83; 95% CI, 1.18 to 2.83; P=0.006; depression, HR, 1.66; 95% CI, 1.06 to 2.58; P=0.025). Estimation of the HR for patients with both anxiety and depression versus those with neither revealed a larger HR than for patients with either factor alone (HR, 3.10; 95% CI, 1.95 to 4.94; P<0.001). CONCLUSIONS: Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co-occurrence of these psychosocial factors as markers of increased mortality risk.
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    Phobic anxiety and increased risk of mortality in coronary heart disease.
    (Psychosom Med, 2010-09) Watkins, Lana L; Blumenthal, James A; Babyak, Michael A; Davidson, Jonathan RT; McCants, Charles B; O'Connor, Christopher; Sketch, Michael H
    OBJECTIVES: To evaluate whether phobic anxiety is associated with increased risk of cardiac mortality in individuals with established coronary heart disease (CHD) and to examine the role of reduced heart rate variability (HRV) in mediating this risk. Previous findings suggest that phobic anxiety may pose increased risk of cardiac mortality in medically healthy cohorts. METHODS: We performed a prospective cohort study in 947 CHD patients recruited during hospitalization for coronary angiography. At baseline, supine recordings of heart rate for HRV were collected, and participants completed the Crown-Crisp phobic anxiety scale. Fatal cardiac events were identified over an average period of 3 years. RESULTS: Female CHD patients reported significantly elevated levels of phobic anxiety when compared with male patients (p < .001), and survival analysis showed an interaction between gender and phobic anxiety in the prediction of cardiac mortality (p = .058) and sudden cardiac death (p = .03). In women, phobic anxiety was associated with a 1.6-fold increased risk of cardiac mortality (hazard ratio, 1.56; 95% confidence interval, 1.15-2.11; p = .004) and a 2.0-fold increased risk of sudden cardiac death (hazard ratio, 2.02; 95% confidence interval, 1.16-3.52; p = .01) and was unassociated with increased mortality risk in men (p = .56). Phobic anxiety was weakly associated with reduced high-frequency HRV in female patients (r = -.14, p = .02), but reduced HRV did not alter the association between phobic anxiety on mortality. CONCLUSIONS: Phobic anxiety levels are high in women with CHD and may be a risk factor for cardiac-related mortality in women diagnosed with CHD. Reduced HRV measured during rest does not seem to mediate phobic anxiety-related risk.