Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease.

Abstract

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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Citation

Published Version (Please cite this version)

10.1161/JAHA.112.000068

Publication Info

Watkins, Lana L, Gary G Koch, Andrew Sherwood, James A Blumenthal, Jonathan RT Davidson, Christopher O'Connor and Michael H Sketch (2013). Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J Am Heart Assoc, 2(2). p. e000068. 10.1161/JAHA.112.000068 Retrieved from https://hdl.handle.net/10161/13048.

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Scholars@Duke

Watkins

Lana L. Watkins

Professor Emeritus in Psychiatry and Behavioral Sciences
  • Examination of the relationship between affective disorders and autonomic cardiovascular control.

    * Examination of the mechanisms underlying the increased cardiac mortality associated with anxiety disorders.

    * Examination of the role of behavioral factors (diet, exercise) as modulators of glycemic control and in the pathogenesis of cardiovascular autonomic neuropathy.
Sketch

Michael Hugh Sketch

Professor Emeritus of Medicine

My current research interests are focused in the area of diagnostic and interventional cardiac catheterization. In the arena of diagnostic cardiac catheterization, I am currently evaluating the role of Prostaglandin E1 in the prevention of contrast induced renal dysfunction. In the arena of interventional cardiac catheterization, I have been actively involved in both the development and subsequent determination of potential niches for new interventional technologies in the management of coronary artery disease. These interventional technologies include balloon angioplasty, the perfusion balloon catheter, transluminal extraction catheter, and several intracoronary stents.


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