title: Depression and Anxiety Screens as Predictors of 8-Year Incidence of Myocardial Infarction and Stroke in Primary Care Patients.
abstract: Because depression and anxiety are typically studied in isolation, our purpose was to examine the relative importance of these overlapping emotional factors in predicting incident cardiovascular disease (CVD).
  
  
  
  We examined depression and anxiety screens, and their individual items, as predictors of incident hard CVD events, myocardial infarction, and stroke for 8 years in a diverse sample of 2041 older primary care patients initially free of CVD. At baseline, participants completed self-report depression and anxiety screens. Data regarding CVD events were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytic files.
  
  
  
  During follow-up, 683 (33%) experienced a CVD event. Cox proportional hazards models-adjusted for demographic and CVD risk factors-revealed that a positive anxiety screen, but not a positive depression screen, was associated with an increased risk of a hard CVD event in separate models (Years 0-3: anxiety hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.21-1.96, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.81-1.21), p = .93; depression HR = 1.10, CI = 0.88-1.36, p = .41), as well as when entered into the same model (Years 0-3: anxiety HR = 1.53, CI = 1.20-1.95, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.80-1.21, p = .99; depression HR = 1.03, CI = 0.82-1.29, p = .82). Analyses examining individual items and secondary outcomes showed that the anxiety-CVD association was largely driven by the feeling anxious item and the myocardial infarction outcome.
  
  
  
  Anxiety, especially feeling anxious, is a unique risk factor for CVD events in older adults, independent of conventional risk factors and depression. Anxiety deserves increased attention as a potential factor relevant to CVD risk stratification and a potential target of CVD primary prevention efforts.
authors.affiliation: From the Department of Psychology (Stewart), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana; Department of Psychology (Hawkins), Oklahoma State University, Stillwater, Oklahoma; Department of Psychology (Khambaty), University of Miami, Coral Gables, Florida; Indiana University Center for Aging Research (Perkins, Callahan) and Department of Medicine (Callahan), Indiana University School of Medicine, Indianapolis, Indiana; and Regenstrief Institute (Callahan), Inc, Indianapolis, Indiana.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Stewart
authors.forename: Misty A W
authors.initials: MA
authors.lastname: Hawkins
authors.forename: Tasneem
authors.initials: T
authors.lastname: Khambaty
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D012306:Risk; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology