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    Phobic anxiety and increased risk of mortality in coronary heart disease.

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    566.1 Kb
    Date
    2010-09
    Authors
    Babyak, MA
    Blumenthal, James Alan
    Davidson, Jonathan RT
    McCants, CB
    O'Connor, Christopher Michael
    Sketch, MH
    Watkins, LL
    Repository Usage Stats
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    Abstract
    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.
    Type
    Journal article
    Subject
    Adult
    Aged
    Aged, 80 and over
    Blood Pressure
    Blood Pressure Determination
    Cohort Studies
    Comorbidity
    Coronary Disease
    Death, Sudden, Cardiac
    Female
    Heart Rate
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    Phobic Disorders
    Proportional Hazards Models
    Prospective Studies
    Rest
    Risk Factors
    Sex Factors
    Survival Analysis
    Permalink
    https://hdl.handle.net/10161/13056
    Published Version (Please cite this version)
    10.1097/PSY.0b013e3181e9f357
    Publication Info
    Babyak, MA; Blumenthal, James Alan; Davidson, Jonathan RT; McCants, CB; O'Connor, Christopher Michael; Sketch, MH; & Watkins, LL (2010). Phobic anxiety and increased risk of mortality in coronary heart disease. Psychosom Med, 72(7). pp. 664-671. 10.1097/PSY.0b013e3181e9f357. Retrieved from https://hdl.handle.net/10161/13056.
    This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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    Scholars@Duke

    Blumenthal

    James Alan Blumenthal

    J. P. Gibbons Professor of Psychiatry I
    Psychosocial factors and coronary heart disease, including such factors as social support, Type A behavior and hostility, and depression, exercise training and depression in the elderly; behavioral approaches to the treatment of hypertension (e.g., weight loss and exercise); cardiac rehabilitation; neuropsychological outcomes following cardiac surgery; psychosocial aspects of heart and lung transplantation; exercise training and osteoarthritis and fibromyalgia; compliance.

    Jonathan R.T. Davidson

    Professor Emeritus of Psychiatry and Behavioral Sciences
    Currently, my research focuses upon the theoretical aspects of homeopathy and its clinical utilization, as well as the broader field of alternative (complementary) medicine. this is a field which has traditionally been overlooked as a legitimate scientific discipline. Other areas of activity are as in the past, i.e., clinical treatment, epidemiology, risk factors, pathogenesis of posttraumatic stress, social phobia, other anxiety status, and depression. These are illustrated by recent pu
    O'Connor

    Christopher Michael O'Connor

    Richard Sean Stack, M.D. / Guidant Foundation Professor of Cardiology
    Dr. O’Connor’s research interests include: acute heart failure; co-morbidities in heart failure; clinical trials; biomarkers; and novel pharmacological and non-pharmacological approaches for the treatment of heart failure.
    Alphabetical list of authors with Scholars@Duke profiles.
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