title: Depression and chest pain in patients with coronary artery disease.
abstract: BACKGROUND
  Depression is common in patients with coronary artery disease (CAD) and is associated with more frequent chest pain. It is however unclear whether this is due to differences in underlying CAD severity. We sought to determine [1] whether depressive symptoms are associated with chest pain independently of CAD severity, [2] whether improvement in depressive symptoms over time is associated with improvement in chest pain and [3] whether the impact of revascularization on chest pain differs between patients with and without depression.
  
  
  RESULTS
  5158 patients (mean age 63±12years, 65% male, 20% African American) undergoing cardiac catheterization completed the Seattle Angina Questionnaire (SAQ) and Patient Health Questionnaire-8 (PHQ-8) to assess angina severity and screen for depression, respectively, both at baseline and between 6 and 24months of follow-up. We found significant correlations between PHQ-8 scores and angina frequency (SAQ-AF, r=-0.28), physical limitation (SAQ-PL, r=-0.32) and disease perception (SAQ-DS r=-0.37, all P<0.001), which remained significant after adjustment for clinical characteristics, CAD severity, and anti-depressant use. Improvement in depressive symptoms at follow-up was associated with improvement in angina subscales (SAQ-AF β 1.34, P<0.001), SAQ-PL β 1.85, P<0.001), and SAQ-DS (β 2.12, P<0.001), independently of CAD severity or revascularization. Patients with depression who underwent revascularization had less improvement in chest pain frequency than those without depressive symptoms.
  
  
  CONCLUSIONS
  Depression is associated with angina, independently of CAD severity. Patients with depression may not derive as adequate symptomatic benefit from revascularization as those without. Whether treatment of underlying depression improves chest pain needs to be further studied.
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Hayek
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Yi-An
authors.initials: YA
authors.lastname: Ko
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Mosaab
authors.initials: M
authors.lastname: Awad
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Andrea
authors.initials: A
authors.lastname: Del Mar Soto
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Hina
authors.initials: H
authors.lastname: Ahmed
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Keyur
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Yuan
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Spencer
authors.initials: S
authors.lastname: Maddox
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Brandon
authors.initials: B
authors.lastname: Gray
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Jamal
authors.initials: J
authors.lastname: Hajjari
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Laurence
authors.initials: L
authors.lastname: Sperling
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Amit
authors.initials: A
authors.lastname: Shah
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: aquyyum@emory.edu.
authors.forename: Arshed A
authors.initials: AA
authors.lastname: Quyyumi
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D000928:Antidepressive Agents / Q000627:therapeutic use; D006328:Cardiac Catheterization; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000928:Antidepressive Agents
keywords: Angina; Depression; PHQ-8; Revascularization; SAQ; Seattle Angina Questionnaire