Symptoms of anxiety and depression in patients with stable coronary heart disease: prognostic value and consideration of pathogenetic links.
BACKGROUND
We evaluated the association of symptoms of anxiety and depression with fatal and non-fatal cardiovascular disease events among patients with coronary heart disease and considered several potential underlying pathogenetic links.


METHODS
This was a prospective cohort study.


METHODS
In this study, including coronary heart disease patients undergoing an in-patient rehabilitation program, symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal cardiovascular disease events were determined during a 3-year follow-up.


RESULTS
Of the 1052 patients with CHD 16.1% showed a borderline and 8.3% a manifest anxiety symptoms score, whereas 11.8 and 5.9% showed a borderline and manifest depressive symptoms score, respectively. During the 3-year follow-up fatal and non-fatal cardiovascular disease events were observed in 73 (6.9%) patients. After adjustment for covariates, patients having manifest anxiety symptoms had a statistically significant hazard ratio (HR) of 2.32 [95% confidence interval (CI) 1.14-4.74] for a cardiovascular disease event, and patients with depressive symptoms had an HR of 1.47 (95% CI 0.62-3.51) compared to other patients. In a model considering anxiety and depressive symptom scores simultaneously, the hazard ratio for a cardiovascular disease event associated with anxiety symptoms increased to 3.31 (95% CI 1.32-8.27), whereas the hazard ratio associated with depressive symptoms decreased (HR 0.62; 95% CI 0.20-1.87). We found a positive association of increased anxiety scores with body mass index and systolic blood pressure.


CONCLUSIONS
The study suggests an important role especially for symptoms of anxiety for long-term prognosis of patients with known coronary heart disease. It furthermore suggests that several pathogenetic links may partly explain the increased risk.
Division of Clinical Epidemiology and Aging Research, The German Cancer Research Center, Heidelberg, Germany. d.rothenbacher@dkfz-heidelberg.de
Dietrich
D
Rothenbacher
Harry
H
Hahmann
Bernd
B
Wüsten
Wolfgang
W
Koenig
Hermann
H
Brenner
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000401:mortality / Q000473:pathology / Q000523:psychology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors