Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease.
BACKGROUND
Anxiety and depression are associated with mechanisms that promote atherosclerosis. Most recent studies of emotional disturbances in coronary artery disease (CAD) have focused on depression only.


OBJECTIVE
To assess the 2-year cardiac prognostic importance of the DSM-IV-based diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) and self-report measures of anxiety and depression and their co-occurrence.


METHODS
Two-year follow-up of 804 patients with stable CAD (649 men) assessed using the Beck Depression Inventory II (BDI-II), the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the Structured Clinical Interview for DSM-IV (masked to self-reports) 2 months after acute coronary syndromes.


METHODS
Major adverse cardiac events (MACEs) (cardiac death, myocardial infarction, cardiac arrest, or nonelective revascularization) in the 2 years after baseline.


RESULTS
Of the 804 patients, 57 (7.1%) met the criteria for MDD [major depressive disorder] and 43 (5.3%) for GAD [generalized anxiety disorder] (11 [1.4%] had comorbidity); 220 (27.4%) had elevated BDI-II [Beck Depression Inventory II] scores (≥14), and 333 (41.4%) had elevated HADS-A [Hospital Anxiety and Depression Scale] scores (≥8), with 21.1% overlap. Major depressive disorder (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.38-4.73), GAD (OR, 2.47; 95% CI, 1.23-4.97), elevated BDI-II (OR, 1.81; 95% CI, 1.20-2.73), elevated HADS-A score (OR, 1.66; 95% CI, 1.12-2.47), and continuous standardized scores on the BDI-II (OR, 1.31; 95% CI, 1.05-1.62) and the HADS-A (OR, 1.43; 95% CI, 1.19-1.73) all predicted MACEs [major adverse cardiac events]. [correction]. After covariate control, only the P value associated with the continuous BDI-II score increased to above .10. Most of the risk associated with elevated symptoms was in patients with psychiatric disorders. However, patients with comorbid MDD and GAD or elevated anxiety and depression symptoms were not at greater MACE risk than those with only 1 factor.


CONCLUSIONS
Anxiety and depression predict greater MACE risk in patients with stable CAD, supporting future research into common genetic, environmental, and pathophysiologic pathways and treatments.
Frasure-Smith
Nancy
N
Department of Psychiatry and School of Nursing, McGill University, Montreal, Quebec, Canada. nancy.frasure-smith@mcgill.ca
Lespérance
François
F
D000368:Aged; D001007:Anxiety / Q000145:classification; D001008:Anxiety Disorders / Q000150:complications*; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology / Q000523:psychology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003863:Depression / Q000145:classification; D003865:Major Depressive Disorder / Q000150:complications*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012306:Risk