Comorbid depression and anxiety symptoms as predictors of cardiovascular events: results from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study.
OBJECTIVE
To study the independent and interactive effects of depression and anxiety symptoms as predictors of cardiovascular disease (CVD) events in a sample of women with suspected myocardial ischemia. Symptoms of depression and anxiety overlap strongly and are independent predictors of CVD events. Although these symptoms commonly co-occur in medical patients, little is known about combined effects of depression and anxiety on CVD risk.


METHODS
A total of 489 women completed a baseline protocol including coronary angiogram, CVD risk factor assessment, and questionnaire-based measures of depression and anxiety symptoms, using the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI), respectively. Participants were followed for a median 5.9 years to track the prevalence of CVD events (stroke, myocardial infarction, heart failure, and CVD-related mortality). We tested the BDI x STAI interaction effect in addition to the BDI and STAI main effects.


RESULTS
Seventy-five women (15.3% of sample) experienced a CVD event, of which 18 were deaths attributed to cardiovascular causes. Results using Cox regression indicated a significant BDI x STAI interaction effect in the prediction of CVD events (p = .02) after covariate adjustment. Simple effect analyses indicated that depression scores were significant predictors of CVD events among women with low anxiety scores (hazard ratio [HR] = 2.3 [in standard deviation units]; 95% Confidence Interval [CI] = 1.3-3.9; p = .005) but not among women with higher levels of anxiety (HR = 0.99; 95% CI = 0.70-1.4; p = .95).


CONCLUSIONS
Among women with suspected myocardial ischemia, the value of depression symptoms for predicting CVD events varied by the severity of comorbid anxiety. These results suggest that the clinical utility of depression measures may be improved by using them in combination with measures of anxiety.
Rutledge
Thomas
T
VA San Diego Healthcare Syste, University of California, San Diego, San Diego, California, USA. Thomas.Rutledge@va.gov
Linke
Sarah E
SE
Krantz
David S
DS
Johnson
B Delia
BD
Bittner
Vera
V
Eastwood
Jo-Ann
JA
Eteiba
Wafia
W
Pepine
Carl J
CJ
Vaccarino
Viola
V
Francis
Jennifer
J
Vido
Diane A
DA
Merz
C Noel Bairey
CN
D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology*; D010555:Personality Inventory / Q000706:statistics & numerical data; D025341:Principal Component Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013577:Syndrome; D014481:United States / Q000453:epidemiology; D016387:Women's Health