Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence

Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease

BACKGROUND

There is conflicting evidence as to the impact of mental health treatment on outcomes in patients with heart disease. The aim of this study was to examine whether individuals who received mental health treatment for anxiety or depression after being hospitalized for ischemic disorders or heart failure had a reduced frequency of rehospitalizations, emergency department visits, or mortality compared with those who did not receive treatment.

METHODS AND RESULTS

A population-based, retrospective, cohort design was used to examine the association between psychotherapy or antidepressant medication prescription and health service utilization and mortality in patients with coronary artery disease or heart failure and comorbid anxiety or depression. Those receiving versus not receiving mental health treatment were compared based on the frequency of rehospitalization, emergency department visits, and mortality. The study sample included 1563 patients who had a mean age of 50.1 years. Individuals who received both forms of mental health treatment for anxiety or depression were 75% less likely to be rehospitalized, 74% less likely to have an emergency department visit, and 66% less likely to die from any cause.

CONCLUSIONS

Mental health treatment for anxiety or depression has a significant impact on outcomes in patients with cardiovascular disease consisting of reduced hospitalizations, emergency department visits, and in some conditions improved survival.

The personality meta-trait of stability and carotid artery atherosclerosis

BACKGROUND

Several personality traits increase the risk for atherosclerotic cardiovascular disease. Because many of these traits are correlated, their associations with disease risk could reflect shared variance, rather than unique contributions of each trait. We examined a higher-order personality trait of Stability as related to preclinical atherosclerosis and tested whether any such relationship might be explained by correlated variation in cardiometabolic risk factors.

METHOD

Among 798 community volunteers, lower-order traits of Neuroticism, Agreeableness, and Conscientiousness were modeled as latent variables (from self- and informant ratings) and used to estimate the second-order factor, Stability. Cardiometabolic risk was similarly modeled from indicators of glycemic control, blood pressure, adiposity, and lipids. Carotid artery atherosclerosis was measured as intima-media thickness (IMT) by duplex ultrasonography.

RESULT

A structural equation model incorporating direct and indirect effects showed lower Stability associated with greater IMT, and this relationship was accounted for by the indirect pathway via cardiometabolic risk. Secondary analyses showed that: (1) Neuroticism, Agreeableness, and Conscientiousness were unrelated to IMT independent of Stability; and (2) Stability predicted variation in IMT when estimated from informant-, but not self-rated, traits.

CONCLUSION

Personality traits may associate with atherosclerotic burden through their shared, rather than unique, variance, as reflected in Stability.

Association Between Risk Factors and Readmission for Patients With Atrial Fibrillation Treated With Catheter Ablation: Results From the Nationwide DenHeart Study

BACKGROUND

Because of high readmission rates for patients treated with ablation for atrial fibrillation (AF), there is great value in nurses knowing which risk factors make the largest contribution to readmission.

OBJECTIVE

The aims of this study were to (1) describe potential risk factors at discharge and (2) describe the associations of risk factors with readmission from 60 days to 1 year after discharge.

METHODS

Data from a national cross-sectional survey exploring patient-reported outcomes were used in conjunction with data from national health registers. This study included patients who had an ablation for AF during a single calendar year. The Hospital Anxiety and Depression Scale and questions on risk factors were included. Sociodemographic and clinical data were collected through registers, and readmissions were examined at 1 year.

RESULTS

In total, 929 of 1320 (response rate, 70%) eligible patients treated with ablation for AF completed the survey. One year after ablation, there were 333 (36%) acute readmissions for AF and 401 (43%) planned readmissions for AF. Readmissions were associated with ischemic heart disease, anxiety, and depression.

CONCLUSION

High observed readmission rates were associated with risk factors that included anxiety and depression. Postablation care should address these risk factors.

The heart & mind trial: intervention with cognitive-behavioural therapy in patients with cardiac disease and anxiety: randomised controlled trial protocol

INTRODUCTION

Patients with cardiac disease often experience anxiety (prevalence about 20%-25%) and have a doubled mortality risk when suffering from anxiety compared with patients without anxiety. This calls for interventions aiming to reduce anxiety.

METHODS AND ANALYSIS

The Heart & Mind Trial consists of three parts: (1) screening of all hospitalised and outpatient cardiac patients with arrhythmia, heart failure or ischaemic heart disease at four university hospitals in Denmark using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A); Patients scoring ≥8 is invited to participate; (2) Assessment of the type of anxiety by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders and (3) Randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive-behavioural therapy (CBT) performed by a CBT-trained cardiac nurse plus usual care or, usual care alone. The primary outcome is anxiety measured with HADS-A at 5 months. Secondary outcomes include anxiety symptoms measured with Becks Anxiety Inventory and heart rate variability. Exploratory outcomes measured at 12 months include blood cortisol (stress response), blood C reactive protein (stress response), health-related quality of life, readmission, mortality and attributable direct costs. A total of 336 patients will be included. The primary analyses are based on the intention-to-treat principle. For the primary outcome, we will use a linear regression model. For the long-term outcomes, mixed regression models will be used including repeated measurements.

ETHICS AND DISSEMINATION

The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (P-2020-894) and the National Committee on Health Research Ethics (H-20066739). Positive, neutral and negative results of the trial will be published.

TRIAL REGISTRATION NUMBER

NCT04582734.

Effectiveness of aromatherapy inhalation on anxiety and haemodynamic variables for patients with cardiovascular disease: A systematic review and meta-analysis

BACKGROUND

Anxiety can negatively affect patients' prognosis in cardiovascular disease. Aromatherapy helps reduce anxiety level in chronic diseases. However, the effectiveness of aromatherapy on anxiety and haemodynamic variables remains uncertain.

OBJECTIVE

To evaluate the evidence for the effectiveness of aromatherapy on anxiety and haemodynamic variables in patients with cardiovascular disease.

DESIGN

A systematic review and meta-analysis.

REVIEW METHODS

The CINAHL COMPLETE, Cochrane Central, Web of Science, Pubmed, Scopus, Science Direct, Ovid and ProQuest databases were searched. The study was conducted in line with the Cochrane and PRISMA guideline. Examination for bias in the included studies was conducted with the Cochrane bias guideline. Heterogeneity and publication bias were evaluated.

RESULTS

Twelve studies published from 2012 to 2020 were included in the meta-analysis. Lavender aromatherapy inhalation was used the most for anxiety in patients. Aromatherapy had a highly significant effect on anxiety, systolic blood pressure and heart rate, a moderate effect on breathing rate and a non-significant effect on diastolic blood pressure. The Cochrane GRADE approach was used to assess the rating of the certainty of evidence. A high level of evidence was found for the effect of aromatherapy on heart rate, a moderate level for the effect of aromatherapy on anxiety and breathing rate and a low level for the effects of aromatherapy on blood pressure and lavender on anxiety.

CONCLUSION

It was found that aromatherapy reduced anxiety, systolic blood pressure, heart rate and breathing rate in patients with cardiovascular disease. This study provides information to researchers and health professionals about the effectiveness of aromatherapy on decreasing anxiety and haemodynamic variables in patients with cardiovascular disease. Also, the study can contribute to planning studies which are better designed, conducted and reported.

Psychophysiological responses of firefighters to day and night rescue interventions

This study aimed 1) to assess the psychophysiological responses throughout a rescue intervention performed during the day and at night and 2) to determine if a vibrating alarm influences these psychophysiological responses at night. Sixteen male firefighters completed a simulated intervention under three different conditions: 1) during the day with a sound alarm signal (Day_SA), 2) during the night with a sound alarm signal (Night_SA), 3) during the night with a vibrating alarm signal (Night_VA). Cardiovascular and psychological stress were recorded throughout the interventions. During the alarm signal, HR reactivity was greater in Night_SA than in Day_SA (p < 0.01). Parasympathetic reactivation and self-confidence were significantly lower in Night_SA than in Day_SA (p < 0.05). HR reactivity was decreased in Night_VA in comparison to Night_SA (p < 0.05). Overall, the rescue intervention had a greater impact on the psychophysiological variables during the night than during the day, and the type of alarm had a minor effect.

Translation of the Amsterdam Preoperative Anxiety and Information Score (APAIS) into the Amharic Version and Its Validation for Evaluation of Preoperative Anxiety

Background

Peri-operative anxiety is a vague, unpleasant feeling, the source of which is often nonspecific and unknown to the individual. It affects all aspects of anesthesia. Although the magnitude and consequences of preoperative anxiety are well documented in the developed world, there are limited studies conducted in Ethiopia. The primary aim of this study is to produce the Amharic version of APAIS and evaluate its validity in assessing the prevalence of preoperative anxiety in surgical patients.

Methods

A cross-cultural adaptation process using a forward/backward translation of the APAIS scale was performed. The Amharic version was then tested in 365 sampled elective adult surgical patients scheduled for surgery at Tikur Anbessa specialized Hospital. The validity of the translated version was also checked by evaluating its psychometric properties of internal validity and acceptability.

Result

The results showed that the reliability of the APAIS-Amharic was high (Cronbach's alpha of 0.87) and the data collected was a good fit (RMSEA of 0.04). In addition, the questionnaire was well-accepted 100% with no missing values for each dimension of the APAIS. The mean APAIS scores for total anxiety and desire for information were 11.6 and 6.0 respectively and 58.9% of the study participants had anxiety and those patients, who had some form of formal education, came from urban areas, had previous anesthesia experience and complications and who had average or high information requirement was more likely to be anxious.

Conclusion

APAIS-Amharic is a reliable and acceptable tool for measuring patients' preoperative anxiety and their need for information. It can be used routinely as a screening instrument at pre-anesthesia clinics to assess patients' level of anxiety.

Effect of Short-Term Yoga-Based-Breathing on Peri-Operative Anxiety in Patients Undergoing Cardiac Surgery

Background

Peri-operative anxiety in patients scheduled for cardiac surgery is detrimental. This study evaluated the effect of short-term yoga based-breathing with different variations on peri-operative anxiety.

Materials and Methods

A prospective randomized controlled study was conducted in patients aged 20-60 years scheduled for major cardiac surgery. Patients in Yoga group were trained for yoga based-breathing with different variations for 5 days; no intervention was done in controls.

Results

We analyzed twenty patients in each group. Anxiety scores measured at baseline, presurgery, and postsurgery were entered as the within-subjects factor; group status was entered as the between-subjects factor in the RMANOVA. Baseline demographics and anxiety scores were comparable. The short-term yoga-based breathing exercise-training program had a statistically significant effect on state (F = 13.45, P < 0.0001), Trait (F = 13.29, P < 0.0001) and total anxiety scores (F = 29.44, P < 0.0001) at different time points for yoga over control group.

Conclusion

Short-term yoga-based breathing for 5 days lowers presurgery and postsurgery anxiety in patients undergoing cardiac surgery.

The association of red meat consumption and mental health in women: A cross-sectional study

OBJECTIVES

Previous studies have shown that red meat consumption has beneficial effects on health. The purpose of this study was to determine the relationship between red meat consumption and depression, anxiety and psychological distress in Tehrani women.

METHODS

In this cross-sectional study, 482 women aged 20-50 years old referred to the health centers of Tehran University of Medical Sciences in 2018 were selected by multistage cluster sampling. The usual dietary intake was evaluated using a semi-quantitative food frequency questionnaire containing 168 items that its validity and reliability were approved previously. The red meat category was defined as the sum of red meats (beef, lamb), and organ meats (beef liver, kidney, and heart, ruminant meat). Psychological disorders were assessed using a validated Depression, Anxiety, Stress Scales (DASS) questionnaires with 21-items. In the logistic regression analysis, the results were adjusted to the confounding factors.

RESULTS

The mean age of the study participants was 31.87 ± 7.6 years. The prevalence of depressive symptoms, anxiety and psychological distress among participants was 34%, 40% and 42%, respectively. After controlling for potential confounders, women in the highest quartile of red meat had a highest prevalence of depressive symptoms (OR: 2.51; 95% CI: 1.32-4.76; p = 0.002), anxiety (OR: 1.82; 95% CI: 1.00-3.29; p = 0.034) and stress (OR: 3.47; 95% CI: 1.88-6.42; p < 0.001) compared with those in the lowest quartile.

CONCLUSIONS

We found a significant association between red meat intake and mental health in women. Prospective studies are needed to confirm these findings.

Lifestyle interventions after ablation for atrial fibrillation: a systematic review

BACKGROUND

Risk factors of atrial fibrillation include diabetes, obesity and physical inactivity. Positive effects such as decreased atrial fibrillation burden have been reported for atrial fibrillation patients who have participated in lifestyle changing interventions after atrial fibrillation ablation treatment.

AIM

The aim of this study was to assess the evidence on the benefits and harms of lifestyle and risk factor management interventions in patients undergoing atrial fibrillation ablation.

METHOD

Our systematic review searched MEDLINE, EMBASE, CINAHL, Psychinfo, Web of Science and CENTRAL using key terms related to atrial fibrillation and lifestyle, including interventional trials. The primary outcomes were mortality and serious adverse events. Random effects meta-analyses of outcomes were conducted when appropriate.

RESULTS

Two randomised controlled trials and two non-randomised interventional trials with a total of 498 patients were included. Six primary events were reported for the intervention groups and five events for the control groups (relative risk of 1.03, 95% confidence interval (CI) 0.3 to 3.1, I² 0%, P = 0.537). Effects in favour of the intervention groups were found for atrial fibrillation frequency (0.82 points, 95% CI -1.60 to -0.03, I² 87.3%, P = 0.005), atrial fibrillation duration (-0.76 points, 95% CI -1.64 to 0.12, I² 89.1%, P = 0.002) and body mass index (-5.40 kg/m², 95% CI 6.22 to -2.57, I² 83.9%, P = 0.013). Risk of bias in the four studies was judged to be low to moderate.

CONCLUSION

Lifestyle changing interventions seem to have a positive effect on outcomes relevant to patients undergoing atrial fibrillation ablation, but the included studies were small, interventions were inhomogeneous, and the quality of evidence was low to moderate. More studies are warranted.

Psychosocial Stress and Cardiovascular Disease

PURPOSE OF REVIEW

This manuscript reviews the epidemiological data linking psychosocial stress to cardiovascular disease (CVD), describes recent advances in understanding the biological pathway between them, discusses potential therapies against stress-related CVD, and identifies future research directions.

RECENT FINDINGS

Metabolic activity of the amygdala (a neural center that is critically involved in the response to stress) can be measured on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) yielding a neurobiological signal that independently predicts subsequent CVD events. Furthermore, a serial pathway from ↑amygdalar activity → ↑hematopoietic tissue activity → ↑arterial inflammation → ↑CVD events has been elucidated, providing new insights into the mechanism linking stress to CVD. Psychosocial stress and stress conditions are independently associated with CVD in a manner that depends on the degree and duration of stress as well as the individual response to a stressor. Nevertheless, the fundamental biology remains incompletely defined, and stress is often confounded by adverse health behaviors. Thus, most clinical guidelines do not yet recognize psychosocial stress as an independent CVD risk factor or advocate for its treatment in CVD prevention. Clarification of this neurobiological pathway provides a better understanding of the underlying pathophysiology and suggests opportunities to develop novel preventive strategies and therapies.

Relationship between major depressive disorder, generalized anxiety disorder and coronary artery disease in the US general population

OBJECTIVE

To evaluate whether the changes and persistence of major depressive disorder (MDD) and generalized anxiety disorder (GAD) affect the risk of incident coronary artery disease (CAD) in the US general population.

METHODS

Data was retrieved from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted in 2001/2002 (Wave 1) and 2004/2005 (Wave 2). At both Wave 1 and one year before Wave 2, MDD and GAD were measured using the Alcohol Use Disorders and Associated Disabilities Interview Schedule IV. CAD was considered present at Wave 1 or Wave 2 based on the participants' self-reported physician diagnosis. Relationship between MDD, GAD and CAD was examined using generalized linear regression model.

RESULTS

The study included 32,345 participants without CAD at Wave 1, with 3.3% developing CAD at Wave 2. After adjustment, persistence of MDD/GAD and GAD predicted highest risk of developing CAD respectively (MDD/GAD: RR = 2.01, 95% CI: 1.54-2.64; GAD: RR = 2.09, 95% CI: 1.22-3.58), while positive changes predicted lowest risk (MDD/GAD: RR = 1.43, 95% CI: 1.15-1.78; GAD: RR = 1.68, 95% CI: 1.21-2.33). Negative change of MDD is associated with highest risk of developing CAD (RR = 2.07, 95% CI: 1.69-2.54), while positive changes predicted lowest risk (RR = 1.38, 95% CI: 1.11-1.73).

CONCLUSIONS

Existence of MDD/GAD, MDD, or GAD increase the risk of new-onset CAD. Positive change in MDD and GAD is associated with reduced risk of incident CAD, which highlights the importance of treating MDD and GAD in preventing the development of CAD.

Association of dietary phytochemical index and mental health in women: a cross-sectional study

Previous studies have shown that unhealthy dietary patterns are among the most important modifiable risk factors in the development of mental health disorders. We examined the association of dietary phytochemical index (DPI) with symptoms of depression, anxiety and psychological distress in Iranian women. In this cross-sectional study, a total of 488 women aged 20–50 years old attending health centres in the south of Tehran in 2018 were included. A validated and reliable FFQ was used for dietary assessment. Symptoms of depression, anxiety and psychological distress were assessed using a validated depression, anxiety, stress scales questionnaires with twenty-one-items. DPI was estimated using the following formula: (daily energy derived from phytochemical-rich foods (kJ)/total daily energy intake (kJ))×100. The mean age of the study participants was 31·9 (sd7·7) years. The prevalence of depressive symptoms, anxiety and psychological distress among study participants was 34·6, 40·6 and 42·4 %, respectively. After controlling for potential confounders, women in the highest tertile of DPI had a lower prevalence of depressive symptoms (OR 0·22; 95 % CI 0·12, 0·38) and anxiety (OR 0·33; 95 % CI 0·20, 0·55), as well as psychological distress (OR 0·30; 95 % CI 0·18, 0·49) compared with those in the lowest tertile. In conclusion, we found a significant association between DPI and mental health in women. Prospective studies are needed to confirm these findings.

The Role of Emotional Competence in Takotsubo Cardiomyopathy

OBJECTIVE

The current study examined the role of emotional competences and depression in takotsubo cardiomyopathy (TTC).

METHODS

We compared 37 TTC patients who experienced emotion triggers (TTC-t: M (SD) age = 66.4 (12.8) years, 33 women) with 37 TTC patients who did not experience emotion triggers (TTC-nt: M (SD) age = 65.8 (11.1) years, 33 women) and 37 patients with acute myocardial infarction who experienced an emotion trigger (AMI-t: M (SD) age = 66.1 (10.1) years, 33 women). Three aspects of emotional competence (emotional intelligence, metacognitive beliefs, and emotional processing deficits) were assessed using the Trait Meta-Mood Scale (TMMS), the Meta-Cognitions Questionnaire 30, and the Emotional Processing Scale. Differences between-group means were evaluated using multivariate analysis of covariance, adjusting for depressive symptom (Hamilton Rating Scale for Depression).

RESULTS

Compared with the TTC-nt and AMI-t comparison groups, TTC-t patients had low scores on emotional intelligence (TMMS Attention: F(2, 184) = 23.10, p < .001; TMMS Repair: F(2, 184) = 11.98, p < .001) and high scores in metacognitive beliefs and emotional processing deficits (e.g., Meta-Cognitions Questionnaire 30 Negative Beliefs about Thoughts: F(2, 184) = 56.93, p < .001), independent of the levels of depressive symptom. TTC-nt patients also had significantly lower scores on the Hamilton Rating Scale for Depression scale compared with AMI-t (p = .021) and TTC-t (p = .004) patients.

CONCLUSIONS

TTC-t patients showed a specific dysfunctional profile of emotional competence, even after adjusting for depressive symptom. These results provided a better understanding of the psychological factors that contribute to TTC.

Twenty-four-hour ambulatory blood pressure monitoring in very elderly patients: Comparison of in-hospital versus home follow-up results

Elevated blood pressure (BP) is frequently diagnosed in very elderly hospitalized patients. Accurate diagnosis of hypertension is challenging in the hospital environment, due to the "white coat effect," and both overtreatment and undertreatment can adversely affect clinical outcome. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has the potential to avoid the "white coat effect" and accurately guide the management of hypertension. However, effects of the hospital environment on ABPM are unknown in the very elderly. We set out to enroll 45 patients, age ≥70 years, with elevated conventional BP during hospitalization in this observational study. It was prespecified by protocol to assess initially the difference between 24-hour BP during hospital-admission and home follow-up. Subsequent analysis should investigate the change in anxiety (Hospital Anxiety and Depression Scale-A [HADS-A]) after discharge, the correlation with change in 24-hour BP after discharge, and the prevalence of orthostatic hypertension. Thirty-one patients were included in the final analysis (age 83.5 ± 4.4 years; 71% female). Twenty-four-hour BP decreased significantly after hospital discharge (systolic from 133.5 ± 15.6 to 126.2 ± 14.4 mm Hg [millimeter of mercury], P = .008; diastolic from 71.0 ± 9.0 to 68.3 ± 8.6 mm Hg, P = .046). Anxiety level (HADS-A) decreased significantly after discharge, from 7.5 (interquartile range [IQR]: 4.0-13.8) to 5.0 (IQR: 4.0-8.0, P = .012). The change in anxiety was a predictor of change in systolic BP after discharge (F[1,20] = 5.9, P = .025). Sixty-one percent of the patients had significant orthostatic hypotension during hospital stay. In conclusion, 24-hour BP in very elderly patients is lower in the home environment than during hospitalization. This phenomenon seems to be directly linked to a lower anxiety-level at home. Reassessing hypertension at home may decrease the need for (intensified) antihypertensive medical therapy in a substantial number of patients. This is particularly important in the very elderly, who have a high prevalence of symptomatic and asymptomatic orthostatic hypotension, making them prone to hazardous effects of antihypertensive therapy.

Overt and Covert Anxiety as a Toxic Factor in Ischemic Heart Disease in Women: The Link Between Psychological Factors and Heart Disease

Background

Long-term clinical observations have shown that anxiety disorders influence the etiopathogenesis of ischemic heart disease (IHD) in women. The aim of this study was to determine the characteristics of the structure of overt and covert anxiety, and to examine the impact of the severity of anxiety on five personality traits as described Costa and McCrae.

Material/Methods

The study involved 50 women aged 37 to 74 years, who were treated because of IHD that was confirmed by angiographic examination of the coronary vessels. Psychological studies were conducted using the IPAT Anxiety Scale (Cattell) and NEO-FFI Personality Inventory (Costa and McCrae).

Results

From among the 50 women with IHD included in the study, 28 had higher overt anxiety scores than covert anxiety scores. Women with high overt anxiety were more emotionally changeable (C−), became impatient more easily, and expressed disappointment with life. They also worried about life problems more frequently. They had considerable suspiciousness (L+) and less trust towards the environment. They had a much stronger tendency to blame themselves (O+) and had intense internal, neurotic tension (Q4+). Women with high levels of overt anxiety had more neurotic traits (NEU), and lower openness to experience (OPE) scores.

Conclusions

Women with IHD were characterized by a high level of unease and anxiety. This may have resulted from lack of personality harmony, lack of personality integrity, or experienced value crises. Internal tension, auto-aggression, lowered emotional stability, and a sense of threat dominate the structure of unease and anxiety.

Threat sensitivity in bipolar disorder

Life stress is a major predictor of the course of bipolar disorder. Few studies have used laboratory paradigms to examine stress reactivity in bipolar disorder, and none have assessed autonomic reactivity to laboratory stressors. In the present investigation we sought to address this gap in the literature. Participants, 27 diagnosed with bipolar I disorder and 24 controls with no history of mood disorder, were asked to complete a complex working memory task presented as "a test of general intelligence." Self-reported emotions were assessed at baseline and after participants were given task instructions; autonomic physiology was assessed at baseline and continuously during the stressor task. Compared to controls, individuals with bipolar disorder reported greater increases in pretask anxiety from baseline and showed greater cardiovascular threat reactivity during the task. Group differences in cardiovascular threat reactivity were significantly correlated with comorbid anxiety in the bipolar group. Our results suggest that a multimethod approach to assessing stress reactivity-including the use of physiological parameters that differentiate between maladaptive and adaptive profiles of stress responding-can yield valuable information regarding stress sensitivity and its associations with negative affectivity in bipolar disorder. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Glucose and Cardiac Risk Factor Control in Individuals With Type 2 Diabetes

Purpose

The purpose of this descriptive study was to describe attainment of glucose and coronary heart disease (CHD) risk factor goals and to identify factors that were associated with successful goal achievement.

Methods

A cross-sectional survey enrolled 110 subjects with type 2 diabetes undergoing screening for asymptomatic myocardial ischemia.

Results

Many participants had HbA1c levels ≥7% (45%), and 46% to 79% were not meeting goals for CHD risk reduction. Individual factors of age, gender, and anxiety; the illness-related factor of lipid-lowering therapy; and the family-related factor of living alone were independently associated with 1 of the 7 outcomes under study. Illness-related factors of a longer duration of diabetes were strongly associated with glucose and blood pressure control, insulin use with glucose control and waist circumference, and antihypertensive use with blood pressure, triglycerides, and body mass index. Family-related factors of higher income were significantly associated with poorer glucose control and higher body mass index, while higher levels of perceived support by family and friends were associated with a lower risk of not meeting lipid goals. However, individual factors, represented by several aspects of personal model beliefs (exercising regularly, testing glucose, and checking one’s feet) and physical activity, were consistently related to lipid and weight control.

Conclusions

A variety of factors were associated with control of blood glucose and CHD risk factors, suggesting that a one-size-fits-all approach to multiple risk factor reduction efforts may not result in goal attainment.

Risk of incident cardiovascular events amongst individuals with anxiety and depression: A prospective cohort study in the east London primary care database

BACKGROUND

It is unknown how risk of myocardial infarction and stroke differ for patients with and without anxiety or depression, and whether this risk can be explained by demographics, medication use, cardiovascular risk factors. The aim of this study is to quantify differences in risk of non-fatal MI or stroke among patients with anxiety or depression.

METHODS

Prospective cohort study examining risk of incident MI and stroke between March 2005 and March 2015 for 524,952 patients aged 30 and over from the east London primary care database for patients with anxiety or depression.

RESULTS

Amongst 21,811 individuals with depression at baseline, 1.2% had MI and 0.4% had stroke. Of 22,128 individuals with anxiety at baseline, 1.1% had MI and 0.3% had stroke. Depression was independently associated with both MI and stroke, whereas anxiety was associated with MI only before adjustment for cardiovascular risk factors. Antidepressant use increased risk for MI but not stroke. Mean age at first MI was lower in those with anxiety, while mean age at first stroke was lower in those with depression.

LIMITATIONS

The study was limited to patients currently registered in the database and thus we did not have any patients that died during the course of follow-up.

CONCLUSIONS

Patients with depression have increased risk of cardiovascular events. The finding of no increased cardiovascular risk in those with anxiety after adjusting for cardiovascular risk factors is of clinical importance and highlights that the adequate control of traditional risk factors is the cornerstone of cardiovascular disease prevention. Targeting management of classical cardiovascular risk factors and evaluating the risks of antidepressant prescribing should be prioritized.

The Screen-ICD trial. Screening for anxiety and cognitive therapy intervention for patients with implanted cardioverter defibrillator (ICD): a randomised controlled trial protocol

INTRODUCTION

Previous research shows that patients with an implanted cardioverter defibrillator (ICD) have a fourfold increased mortality risk when suffering from anxiety compared with ICD patients without anxiety. This research supports the screening of ICD patients for anxiety with the purpose of starting relevant intervention.

METHODS AND ANALYSIS

Screen-ICD consists of 3 parts: (1) screening of all hospitalised and outpatient patients at two university hospitals using the Hospital Anxiety and Depression Scale (HADS), scores ≥8 are invited to participate. (2) Assessment of type of anxiety by Structured Clinical Interview for DSM Disorders (SCID). (3) Investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive-behavioural therapy (CBT) performed by a cardiac nurse with CBT training, plus usual care or usual care alone. The primary outcome is HADS-A measured at 16 weeks. Secondary outcomes include Becks Anxiety Inventory, HeartQoL, Hamilton Anxiety Scale, heart rate variability, ICD shock, time to first shock and antitachycardia pacing. A total of 88 participants will be included. The primary analyses are based on the intention-to-treat principle and we use a mixed model with repeated measurements for continuous outcomes. For binary outcomes (HADS-A score <8), we use a generalised mixed model with repeated measurements.

ETHICS AND DISSEMINATION

The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (RH-2015-282) and the regional ethics committee (H-16018868). Positive, neutral and negative results of the trial will be published.

TRIAL REGISTRATION NUMBER

NCT02713360.

Do Negative Emotions Predict Alcohol Consumption, Saturated Fat Intake, and Physical Activity in Older Adults?

This study examined anger, depression, and stress as related to alcohol consumption, saturated fat intake, and physical activity. Participants were 23 older adults enrolled in either an outpatient or in-residence executive health program. Participants completed (a) a health-risk appraisal assessing medical history and current health habits, (b) the State-Trait Anger Expression Inventory (STAXI), and (c) the Center for Epidemiological Studies-Depression Questionnaire. Bivariate correlations revealed that anxiety was negatively correlated with alcohol consumption. High levels of depression, trait anger, and outward anger expression style were positively associated with saturated fat intake. Trait anger was also associated with less aerobic exercise. Inward anger expression was positively correlated with regular participation in strength training. Results suggest that anger, anger expression style, and depression interact with healthy and unhealthy behavior patterns and that these interactions may be complex.

Eliciting Causal Beliefs about Heart Attacks: A Comparison of Implicit and Explicit Methods

Objective

To compare beliefs about the importance of different factors in causing heart attacks, elicited by explicit questionnaire ratings and an implicit vignette task.

Method

In two separate studies: (1) 107 adults (aged 40-60 years); and (2) 134 students completed two tasks: (a) a questionnaire in which they explicitly rated the importance of a number of causes of heart attacks; and (b) a vignette task in which they implicitly used risk factor information to estimate a hypothetical man’s likelihood of a heart attack.

Results

In both studies, family history was rated as a significantly less important cause than smoking or stress on the explicit questionnaire; in the implicit task, smoking and family history exerted a much greater influence on estimates of risk than did stress.

Discussion

The causal beliefs elicited by the two methods differ in important respects. The predictive validity of each measure, alone and in combination with other nonquestionnaire-based measures, needs to be determined.

Physical Activity: Depression, Anxiety, Physical Activity, and Cardiovascular Disease: What's the Connection?

Depression and anxiety are major public health problems and have been shown to be associated with increased risk for cardiovascular disease. The prevalence and incidence of depression and anxiety are lower in those who are regularly active. Regular physical activity has also been shown to reduce symptoms of depression and anxiety in those who already suffer from these disorders. Depression and anxiety may increase the risk for cardiovascular disease by a number of mechanisms, including hypertension and reduced vascular function, autonomic nervous system dysfunction, and increased platelet activity and aggregation. Regular physical activity has been demonstrated to lower blood pressure and improve nitric oxide— mediated vascular function, increase heart rate variability and baroreflex sensitivity, increase fibrinolysis, and, possibly, decrease platelet activity. Little or no work has been done to determine the optimal amount or intensity of exercise to prevent or reduce the symptoms of depression and anxiety. Based on the limited data available, a physical activity routine consistent with the 1996 Surgeon General's Report on Physical Activity and Health is appropriate—specifically, at least 30 minutes of moderate-intensity activity on most days, if not every day, of the week. Little evidence supports a dose-response relation between physical activity and depression or any of the physiological mechanisms discussed here. This is not to say that there is no such relationship but, rather, that well-controlled studies are lacking. Studies on anxiety, especially, are lacking. This includes the link with cardiovascular disease, physiological mechanisms, and the effects of regular physical activity.

The impact of psychotherapy treatments of different length and type on health behaviour during a five-year follow-up

OBJECTIVE

The aim of this study was to investigate the influence of psychotherapy treatments of different lengths, number of sessions, and type on health behaviour.

METHOD

A total of 367 patients were monitored for their health behaviour (alcohol consumption, body mass index), serum cholesterol (total and HDL), smoking and exercise) for five years from the start of the therapy. The effectiveness of solution-focused therapy, short-term psychodynamic psychotherapy, and long-term psychodynamic psychotherapy (LPP) was examined in a randomized clinical trial, while the LPP group and the non-randomized psychoanalysis (PA) group were compared in a naturalistic design.

RESULTS

During the follow-up, an improvement was seen with regard to alcohol consumption, serum HDL cholesterol, and smoking in the LPP and PA groups. No notable differences in health behaviour between the two groups were found, however. During the last two years of the follow-up, changes towards higher alcohol consumption and higher total serum cholesterol levels were observed in the short-term therapy groups.

CONCLUSIONS

The impact of PA and LPP on health behaviour did not differ, whereas the changes were less health promoting in short-term psychotherapy. Large-scale studies are needed to confirm these findings.

Molecular mechanisms of D-cycloserine in facilitating fear extinction: insights from RNAseq

D-cycloserine (DCS) has been shown to be effective in facilitating fear extinction in animal and human studies, however the precise mechanisms whereby the co-administration of DCS and behavioural fear extinction reduce fear are still unclear. This study investigated the molecular mechanisms of intrahippocampally administered D-cycloserine in facilitating fear extinction in a contextual fear conditioning animal model. Male Sprague Dawley rats (n = 120) were grouped into four experimental groups (n = 30) based on fear conditioning and intrahippocampal administration of either DCS or saline. The light/dark avoidance test was used to differentiate maladapted (MA) (anxious) from well-adapted (WA) (not anxious) subgroups. RNA extracted from the left dorsal hippocampus was used for RNA sequencing and gene expression data was compared between six fear-conditioned + saline MA (FEAR + SALINE MA) and six fear-conditioned + DCS WA (FEAR + DCS WA) animals. Of the 424 significantly downregulated and 25 significantly upregulated genes identified in the FEAR + DCS WA group compared to the FEAR + SALINE MA group, 121 downregulated and nine upregulated genes were predicted to be relevant to fear conditioning and anxiety and stress-related disorders. The majority of downregulated genes transcribed immune, proinflammatory and oxidative stress systems molecules. These molecules mediate neuroinflammation and cause neuronal damage. DCS also regulated genes involved in learning and memory processes, and genes associated with anxiety, stress-related disorders and co-occurring diseases (e.g., cardiovascular diseases, digestive system diseases and nervous system diseases). Identifying the molecular underpinnings of DCS-mediated fear extinction brings us closer to understanding the process of fear extinction.

Lifestyle modification for resistant hypertension: The TRIUMPH randomized clinical trial

BACKGROUND

Resistant hypertension (RH) is a growing health burden in this country affecting as many as 1 in 5 adults being treated for hypertension. Resistant hypertension is associated with increased risk of adverse cardiovascular disease (CVD) events and all-cause mortality. Strategies to reduce blood pressure (BP) in this high-risk population are a national priority.

METHODS

TRIUMPH is a single-site, prospective, randomized clinical trial to evaluate the efficacy of a center-based lifestyle intervention consisting of exercise training, reduced sodium and calorie Dietary Approaches to Stop Hypertension eating plan, and weight management compared to standardized education and physician advice in treating patients with RH. Patients (n = 150) will be randomized in a 2:1 ratio to receive either a 4-month supervised lifestyle intervention delivered in the setting of a cardiac rehabilitation center or to a standardized behavioral counseling session to simulate real-world medical practice. The primary end point is clinic BP; secondary end points include ambulatory BP and an array of CVD biomarkers including left ventricular hypertrophy, arterial stiffness, baroreceptor reflex sensitivity, insulin resistance, lipids, sympathetic nervous system activity, and inflammatory markers. Lifestyle habits, BP, and CVD risk factors also will be measured at 1-year follow-up.

CONCLUSIONS

The TRIUMPH randomized clinical trial (ClinicalTrials.gov NCT02342808) is designed to test the efficacy of an intensive, center-based lifestyle intervention compared to a standardized education and physician advice counseling session on BP and CVD biomarkers in patients with RH after 4 months of treatment and will determine whether lifestyle changes can be maintained for a year.

Adherence to the DASH diet in relation to psychological profile of Iranian adults

INTRODUCTION

Although empirically derived dietary patterns have been examined in relation to depression, limited data are available linking theory-based dietary patterns and psychological health.

OBJECTIVE

We aimed to investigate the association between adherence to DASH-style diet and psychological health among Iranian adults.

METHODS

This cross-sectional study was done among 3846 general public adults in Isfahan, Iran. Dietary assessment was conducted using a validated 106-item dish-based semiquantitative food frequency questionnaire. To investigate participants' adherence to DASH-style diet, we created DASH score based on earlier publications focusing on eight components (fruits, vegetables, nuts and legumes, dairy products, grains, sweetened beverages and sweets, sodium, and red and processed meats). Participants were classified into three categories based on their DASH score [low (≤40), moderate (41-50), and high adherence (≥51)]. This categorization, instead of distribution-based classification, was used due to low adherence to the DASH dietary pattern in the study population. Psychological health was examined by means of validated Hospital Anxiety and Depression Scale and General Health Questionnaire. Depression, anxiety, and psychological distress were defined based on standard criteria.

RESULTS

We found that moderate adherence to DASH-style diet was associated with lower odds of depression (OR 0.73; 95 % CI 0.59-0.90, P _trend = 0.63) compared with those with the lowest adherence. In our stratified analyses, these associations remained significant for women (0.70; 0.54-0.91) and for normal-weight participants (0.70; 0.52-0.92). Moreover, after controlling for potential confounders, an inverse association was observed between high adherence to DASH-style diet and anxiety in normal-weight participants (0.61; 0.37-0.98). Such associations were also seen between moderate adherence to DASH-eating style and anxiety in overweight or obese individuals (0.63; 0.42-0.95). We failed to find any significant association between consumption of DASH-style diet and psychological distress.

CONCLUSION

We found an inverse association between moderate adherence to DASH dietary pattern and depression. Further prospective studies are required to confirm these findings.

Psychosocial interventions for patients with coronary heart disease and depression: A systematic review and meta-analysis

INTRODUCTION

Depression is common in patients with coronary heart disease, and together these conditions significantly affect health outcomes. Impaired social support is also considered an important predictor of coronary heart disease prognosis and, as there is a complex interplay between social isolation and depression, interventions to address both may be required. This review aimed to assess the effectiveness of psychosocial interventions addressing both depression and social support for people with coronary heart disease and depression.

METHODS

PRISMA guidelines were used to search major health databases to identify randomised controlled trials that evaluated psychosocial interventions compared with usual care in patients with coronary heart disease and depression; the primary outcome was depressive symptoms and secondary outcomes were mortality (all-cause and cardiac), myocardial infarction, revascularisation, anxiety, social support and quality of life. Data, when suitable, were pooled using a random-effects meta-analysis model.

RESULTS

Five studies (n=1358 participants) were eligible and included. The psychosocial intervention group had significantly lower levels of depressive symptoms (standardised mean difference (SMD) -0.15, 95% confidence interval (CI) -0.27 to -0.03; P=0.02) and higher levels of social support (SMD 0.17; 95% CI 0.04 to 0.30; P=0.01) but no differences were found for mortality (all-cause and cardiac), myocardial infarction, revascularisation, anxiety or quality of life.

CONCLUSIONS

Psychosocial interventions for patients with coronary heart disease and depression result in modest reductions in depressive symptoms and improvements in social support. However, caution is warranted in view of the small number of studies included in the review and potential heterogeneity in outcomes and in differences in treatment.

Influence of Intensity and Duration of Yoga on Anxiety and Depression Scores Associated with Chronic Illness

Background:

Chronic illness is commonly associated with anxiety and depression. Both anxiety and depression respond to yoga. However, there is no report on the association between the intensity and duration of yoga practice with the benefits seen.

Aim:

The present study was intended to determine whether the daily duration of yoga practice and the duration of experience in months would predict anxiety and depression, associated with chronic illness.

Subjects and Methods:

Seven hundred and sixty-three volunteers with ages between 14 and 86 years (group mean age standard deviation, 50.2 [14.2]) who attended a 7 day residential yoga camp in the north of India were included in this cross-sectional study. All participants had chronic illnesses, which were under control with treatment, and which were categorized and are detailed. Participants were assessed for state anxiety scores using State-Trait Anxiety Inventory and for anxiety with hospital anxiety and depression scale (HADS-A), and depression was assessed using HADS-D scores of the HADS. Linear multiple regression analyses were performed using PASW SPSS version 18.0 (Armonk, New York, U.S.) to determine how the daily and monthly duration of yoga practice could influence state anxiety, hospital anxiety and depression of the participants.

Results:

Yoga practice in months and the time spent practicing yoga each day significantly predict the level of state anxiety (P < 0.001, P = 0.03) and HAD-A (P < 0.01, P < 0.01). The duration of yoga practice in months alone was a significant predictor of the HAD-D (P < 0.01).

Conclusions:

The results suggest that the duration of yoga practice in months and daily practice in minutes predict anxiety associated with chronic illness. In contrast the duration of yoga practice in months alone, predicted depression scores.

Increased risk of hypertension in patients with anxiety disorders: a population-based study

OBJECTIVE

We designed this study to examine the prevalence and incidence of hypertension and risk factors in patients with anxiety disorders.

METHODS

The National Health Research Institute provided a database of 1,000,000 random subjects for study. We obtained a random sample of 766,427 subjects aged ≥18years in 2005. The differences in the prevalence of hypertension between patients with anxiety disorders and the general population in 2005 were tested by multiple logistic regression adjusted for other covariates, including age, sex, insurance amount, region, urbanicity and depression. The differences in the incidence of hypertension between patients with anxiety disorders and the general population according to age group and sex from 2006 to 2010 were tested by a Cox regression adjusted for the other covariates.

RESULTS

The prevalence of hypertension in patients with anxiety disorders was higher than that in the general population (37.9% vs. 12.4%, odds ratio, 2.61; 95% confidence interval, 2.52-2.70) in 2005. The average annual incidence of hypertension in patients with anxiety disorders from 2006 to 2010 was also higher than that in the general population (3.63% vs. 1.95%, risk ratio, 1.29; 95% confidence interval, 1.23-1.36). Compared with the general population, patients with anxiety disorders had a higher incidence of hypertension in all age and sex groups.

CONCLUSIONS

Patients with anxiety disorders had a higher prevalence and a higher incidence of hypertension than that in the general population. Age, male sex, diabetes, and hyperlipidemia were risk factors for hypertension in patients with anxiety disorders.

Changes in language use mediate expressive writing's benefits on health-related quality of life following myocardial infarction

The present study assessed linguistic mediators on the effects of expressive writing on health-related quality of life (HRQOL), depression and anxiety following myocardial infarction (MI). One hundred and twenty-one cardiac patients were randomised (expressive writing = 61; control = 60), 98 (expressive writing = 47; control = 51) provided pre- and post-data, with 89 (expressive writing = 43; control = 46) completing the three-month follow-up. The expressive writing group wrote (20 mins/day for three consecutive days) about their thoughts and feelings regarding their MI, and the control group wrote (20 mins/day for three consecutive days) about daily events that occurred during the year prior to the MI. The outcome measures of depression, anxiety and HRQOL were completed pre-randomisation, post-intervention and three months post-intervention; the mediating variables assessed were changes in (a) positive emotion words, (b) negative emotion words and (c) cognitive-processing words. Three months post-intervention, the expressive writing group had significantly higher HRQOL. The positive effects of expressive writing were significantly associated with increases in both positive emotion words and cognitive-processing words across the three days of expressive writing. Expressive writing is a beneficial intervention that may enhance HRQOL among cardiac patients.

The interaction between anxiety and depressive symptoms on brachial artery reactivity in cardiac patients

The association between anxiety, depression, and endothelial function (EF) was assessed in a sample of 295 cardiac outpatients (n=222 men; mean age=59). Patients were administered the Beck Depression Inventory-II and the State-Trait Anxiety Inventory, trait scale. EF was assessed through forearm hyperemic reactivity, a nuclear medicine variation of the flow-mediated dilatation technique, which calculates the rate of uptake ratio (RUR) between hyperaemic and non-hyperaemic arms. Neither effect of anxiety (F=1.40, p=.24) nor depression (F=2.66, p=.10) was found in a model predicting EF, however there was an interaction (F=4.11, p=.04). Higher anxiety and lower depressive symptoms were associated with superior RUR compared to lower anxiety and lower depressive symptoms. Anxiety had no influence on RUR in those patients with higher depressive symptoms, who generally displayed the lowest levels of RUR, i.e., poor function. It is speculative whether this potential protective role of anxiety may be guided by behavioral or physiological mechanisms.

Comorbidity clusters in autism spectrum disorders: an electronic health record time-series analysis

OBJECTIVE

The distinct trajectories of patients with autism spectrum disorders (ASDs) have not been extensively studied, particularly regarding clinical manifestations beyond the neurobehavioral criteria from the Diagnostic and Statistical Manual of Mental Disorders. The objective of this study was to investigate the patterns of co-occurrence of medical comorbidities in ASDs.

METHODS

International Classification of Diseases, Ninth Revision codes from patients aged at least 15 years and a diagnosis of ASD were obtained from electronic medical records. These codes were aggregated by using phenotype-wide association studies categories and processed into 1350-dimensional vectors describing the counts of the most common categories in 6-month blocks between the ages of 0 to 15. Hierarchical clustering was used to identify subgroups with distinct courses.

RESULTS

Four subgroups were identified. The first was characterized by seizures (n = 120, subgroup prevalence 77.5%). The second (n = 197) was characterized by multisystem disorders including gastrointestinal disorders (prevalence 24.3%) and auditory disorders and infections (prevalence 87.8%), and the third was characterized by psychiatric disorders (n = 212, prevalence 33.0%). The last group (n = 4316) could not be further resolved. The prevalence of psychiatric disorders was uncorrelated with seizure activity (P = .17), but a significant correlation existed between gastrointestinal disorders and seizures (P < .001). The correlation results were replicated by using a second sample of 496 individuals from a different geographic region.

CONCLUSIONS

Three distinct patterns of medical trajectories were identified by unsupervised clustering of electronic health record diagnoses. These may point to distinct etiologies with different genetic and environmental contributions. Additional clinical and molecular characterizations will be required to further delineate these subgroups.

In Sickness and in Health: a Literature Review about Function of Social Support within Anxiety and Heart Disease Association

A narrative review of the major evidence concerning the relationship between anxiety, social support and cardiac disease was conducted. Literature demonstrates that a strict relationship between anxiety, social support and cardiac disease outcomes subsists. However, the function of social support within anxiety and heart disease association remains unclear and needs to further researches to be established. Moreover evidence suggests that it's the quality of close relationships to play an important role in affecting psychological and physiological health status. The main components that the literature suggests for a better quality of social support and close relationship, and the main assessment measure are presented. Evidence about cardiac rehabilitation programs and the need to assess and intervene on psychological and psychosocial factors is discussed.

Prospective study of anxiety and incident stroke

BACKGROUND AND PURPOSE

Higher levels of anxiety are associated with increased risk for coronary heart disease. However, few studies have investigated whether anxiety is associated with stroke risk. The purpose of this study was to examine the association between anxiety symptoms and incident stroke in a nationally representative longitudinal study of the US population.

METHODS

Participants (n=6019) in the First National Health and Nutrition Examination Survey were assessed at baseline and followed for 16.29±4.75 years. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals of incident stroke associated with a 1 SD increase in anxiety symptoms. Models were adjusted for standard cardiovascular risk factors and additionally for depression.

RESULTS

A total of 419 incident stroke cases were identified from hospital/nursing home discharge reports and death certificates. Reporting more anxiety symptoms at baseline was associated with increased risk of incident stroke after adjusting for standard biological and behavioral cardiovascular risk factors (hazard ratio, 1.14; 95% confidence interval, 1.03-1.25). Findings persisted when additionally controlling for depression. Exploratory analyses considering the role of potential confounding versus pathway variables suggested that behavioral factors may be a key pathway linking anxiety to stroke risk.

CONCLUSIONS

Higher anxiety symptom levels were associated prospectively with increased risk for incident stroke independent of other risk factors, including depression. Anxiety is a modifiable experience that is highly prevalent among the general population. Its assessment and treatment may contribute to developing more effective preventive and intervention strategies for improving overall cardiovascular health.

A brief cognitive-behavioral intervention for treating depression and panic disorder in patients with noncardiac chest pain: a 24-week randomized controlled trial

BACKGROUND

Most patients with noncardiac chest pain experience anxiety and depressive symptoms. Commonly they are reassured and referred back to primary care, leaving them undiagnosed and untreated. Some small studies have suggested efficacy of 12 cognitive behavioral therapy (CBT) sessions. Our aim was to examine efficacy of brief CBT in reducing anxiety and depressive symptoms in patients with noncardiac chest pain and comorbid panic and/or depressive disorders.

METHODS

In this 24-week randomized controlled trial comparing CBT (n = 60) versus treatment as usual (TAU, n = 53), we included all adults who presented at the cardiac emergency unit of a university hospital with noncardiac chest pain, scored ≥8 on the hospital anxiety and depression scale (HADS) and were diagnosed with a comorbid panic and/or depressive disorder with the Mini International Neuropsychiatric Interview. CBT consisted of six individual sessions. Main outcome was disease severity assessed with the clinical global inventory (CGI) by a blinded independent rater.

RESULTS

ANCOVA in the intention-to-treat and completer sample showed that CBT was superior to TAU after 24 weeks in reducing disease severity assessed with CGI (P < .001). Secondary outcomes on anxiety (HADS-anxiety, state trait anxiety inventory (STAI)-trait) and depressive symptoms (Hamilton depression rating scale) were in line with these results except for HADS-depression (P = .10), fear questionnaire (P = .13), and STAI-state (P = .11).

CONCLUSIONS

Brief CBT significantly reduces anxiety and depressive symptoms in patients with noncardiac chest pain who are diagnosed with panic and/or depressive disorders. Patients presenting with noncardiac chest pain should be screened for psychopathology and if positive, CBT should be considered.

An anxious heart: anxiety and the onset of cardiovascular diseases

The public health burden of cardiovascular disease (CVD) is high both in terms of economic and social costs. Key modifiable factors identified for CVD prevention include health behaviors and health risk factors (e.g., cholesterol, blood pressure). However, a substantial body of research has also identified stress, anxiety, and depression as potentially modifiable CVD risk factors. Here we focus on the role of anxiety in the development of CVD and consider its potential as a key target for primordial prevention strategies. First, we highlight important findings and summarize the latest research on anxiety and incident CVD. We also review and summarize the findings to date on subclinical CVD outcomes and briefly consider mechanisms by which anxiety may influence CVD. We identify key issues and consider how these issues may inform our understanding of the anxiety-CVD relationship. Finally, we briefly discuss the clinical implications of this work, with specific recommendations for providers.

Binge eating as a determinant of emotional state in overweight and obese males with cardiovascular disease

OBJECTIVES

The present study investigates the association between depression, anxiety and binge eating at baseline with weight-change after an approximately 1-year period in a clinical sample of obese adult males with cardiovascular disease.

METHODS

At the time of the first measurement, the sample consisted of 69 overweight and obese men (age range between 36 and 74); 34 patients attended a follow-up measurement 6-17 months after the first measurement, and completed selected psychological instruments.

RESULTS

After the follow-up period, only 28.7% patients' lost weight, 29.9% patients' had the same weight, and finally 41.4% patients' gained weight. When comparing the first and the second assessments, the level of anxiety and depression is relatively stable. Men, who, at the time of the second assessment, gained weight, and were binge eating at baseline, were more depressed and anxious in comparison with the other two groups of patients.

CONCLUSIONS

It is necessary to focus primarily on binge eating symptoms as a part of weight reduction treatment as well as to treat anxiety and depression in CVD patients. Binge eating is an eating disorder per se, and therefore it is important to treat it before the person starts weight reduction procedures as part of the risk prevention treatment for CVD patients.

The Roles of Implicit Memory Bias, Depression, and Metacognitions in Men and Women With Coronary Artery Disease

The purpose of this research was to examine the role of implicit memory bias, depression, and metacognitions in coronary artery disease (CAD) and the relationships between implicit memory bias, depression, and metacognitions based on gender, age, and educational status. Participants were 30 patients with CAD and controls who were selected through a purposive sampling method in Iran. A demographic questionnaire, the Meta-Worry Questionnaire-30; the Beck’s Depression Inventory–II; and the Word Stem Completion Software were used in this study. Resulting data demonstrated that patients with CAD had significant higher levels of depression, metacognitive worry, and negative-mood-inducing words than individuals in the control group. Also, individuals in the control group had significant higher performance on neutral-mood-inducing words than patients with CAD. Depression and metacognitive variables were significantly related to negative- and neutral-mood-inducing words in the total sample. Findings did not support significant relationships of age and educational level to depression, metacognition, and the implicit memory bias in males and females.

A practical quantification of blood glucose production due to high-level chronic stress

Blood glucose (BG) is the primary metabolic fuel for, among others, cancer cell progression, cardiovascular disease and inflammation. Stress is an important contributor to the amount of BG produced especially by the liver. In this paper, we attempt to quantify the BG production due to chronic (in the order of weeks) high-level psychological stress in a manner that a lay person will understand. Three independent approaches were used. The first approach was based on a literature survey of stress hormone data from healthy individuals and its subsequent mathematical manipulation. The next approach was a deductive process where BG levels could be deduced from published stress data of large cardiovascular clinical trials. The third approach used empirical BG data and a BG simulation model. The three different methods produced an average BG increase of 2.2-fold above basal for high levels of stress over a period of more than a day. The standard deviation normalized to the average value was 4.5%.

Vasomotor symptoms and lipid profiles in women transitioning through menopause

OBJECTIVE

To examine associations between vasomotor symptoms and lipids over 8 years, controlling for other cardiovascular risk factors, estradiol, and follicle-stimulating hormone.

METHODS

Study of Women's Health Across the Nation participants (N=3,201), aged 42-52 years at entry, completed interviews on frequency of hot flushes and night sweats (none, 1-5 days, 6 days or more, in the past 2 weeks) physical measures (blood pressure, height, weight), and blood draws (low-density lipoprotein [LDL], high-density lipoprotein [HDL], apolipoprotein A-1, apolipoprotein B, lipoprotein[a], triglycerides, serum estradiol, follicle-stimulating hormone) yearly for 8 years. Relations between symptoms and lipids were examined in linear mixed models adjusting for cardiovascular risk factors, medications, and hormones.

RESULTS

Compared with no flushes, experiencing hot flushes was associated with significantly higher LDL (1-5 days: β [standard error]=1.48 [0.47], P<.01; 6 days or more: β [standard error]=2.13 [0.62], P<.001), HDL (1-5 days: β [standard error]=0.30 [0.18]; 6 days or more: β [standard error]=0.77 [0.24], P<.01), apolipoprotein A-1 (1-5 days: β [standard error]=0.92 [0.47], P<.10; 6 days or more: β [standard error]=1.97 [0.62], P<.01), apolipoprotein B (1-5 days: β [standard error]=1.41 [0.41], P<.001; 6 days or more: β [standard error]=2.51 [0.54], P<.001), and triglycerides (1-5 days: percent change [95% confidence interval]=2.91 [1.41-4.43], P<.001; 6 days or more: percent change [95% confidence interval[=5.90 [3.86-7.97], P<.001) in multivariable models. Findings largely persisted adjusting for hormones. Estimated mean differences in lipid levels between hot flushes 6 days or more compared with no days ranged from less than 1 (for HDL) to 10 mg/dL (for triglycerides). Night sweats were similar. Associations were strongest for lean women.

CONCLUSION

Vasomotor symptoms were associated with higher LDL, HDL, apolipoprotein A-1, apolipoprotein B, and triglycerides. Lipids should be considered in links between hot flushes and cardiovascular risk.

LEVEL OF EVIDENCE

II.

WELL.ME - Wellbeing therapy based on real-time personalized mobile architecture, vs. cognitive therapy, to reduce psychological distress and promote healthy lifestyle in cardiovascular disease patients: study protocol for a randomized controlled trial

BACKGROUND

There is compelling evidence that psychological factors may have the same or even greater impact on the possibility of adverse events on cardiac diseases (CD) than other traditional clinical risk factors. Anxiety and depression are predictors of short- and long-term adverse outcomes, increased risk for higher rates of in-hospital complications, re-infarction, malignant arrhythmias, and mortality in CD patients. Despite researchers finding that cognitive behavior therapy (CBT) reduced depressive and anxiety symptoms, the fact that such results are maintained only in the short term and the lack of maintenance of the long-term affects the absence of changes in lifestyles, preventing the possibility of a wide generalization of results. Recently wellbeing therapy (WBT) has been proposed as a useful approach to improve healthy lifestyle behaviors and reduce psychological distress.

METHODS/DESIGN

The present randomized controlled study will test WBT, in comparison with CBT, as far as the reduction of symptoms of depression, anxiety and psychological distress, and the improvement of lifestyle behaviors and quality of life in cardiac patients are concerned. Moreover, innovations in communication technologies allow patients to be constantly followed in real life. Therefore WBT based on personalized mobile technology will allow the testing of its effectiveness in comparison with usual WBT.

DISCUSSION

The present study is a large outpatient study on the treatment of co-morbid depression, anxiety, and psychological distress in cardiac patients. The most important issues of this study are its randomized design, the focus on promotion of health-related behaviors, and the use of innovative technologies supporting patients' wellbeing in real life and in a continuous way. First results are expected in 2012.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01543815.

Comparative assessment of cardiometabolic risk factor role in high-stress occupations

Aim. To investigate the components of metabolic syndrome (MS) and to evaluate the role of cardiometabolic risk factors (RFs) in high-stress vs. low-stress occupations, in order to enable early diagnostics of the most important factors. Material and methods. In total, 299 men were examined (mean age 43,25±7,75 years). Group I worked as train drivers (n=185), while Group II included railway track workers (n=114). All participants underwent clinical examination, measurement of body mass index, waist circumference (WC), office blood pressure (BP), blood glucose, and lipid profile. MS was diagnosed according to the criteria by IDF (2005), ATP III (2005), and the Society of Cardiology of the Russian Federation (2009). Results. Group I, compared to Group II, demonstrated higher prevalence (p<0,05) of smoking (+22%); abdominal obesity (AO), as denoted by WC ≥94 cm (+28%) or WC 94-102 cm (+16%); elevated systolic BP, SBP (+36%); total cholesterol, TCH (+12%) and very low density lipoprotein cholesterol, VLDL-CH (+16%). The most prevalent combination of MS components among individuals in a high-stress occupation was AH and AO. In Group I, MS prevalence ranged from 30% to 49% (p<0,05) and was 2,5-2,7 times higher than in Group II (p<0,001). Conclusion. Individuals in high-stress occupations demonstrated high prevalence of cardiometabolic RFs and MS. Based on strict MS criteria, early preventive measures among people in high-stress occupations should target individuals with WC 94-102 cm combined with other cardiovascular RFs.

Evaluation of anxiety and depression in patients prior to myocardial perfusion scintigraphy

OBJECTIVE

In myocardial perfusion scintigraphy (MPS) negative results indicate coronary artery diseases which might cause prominent anxiety and other psychological reactions. The aim of this study was to determine anxiety and depression levels of patients prior to MPS procedures.

METHODS

The Hospital Anxiety Depression Scale(HADS) and the State and Trait Anxiety Inventory I and II were used to evaluate the anxiety and depression levels of the patients. Descriptive analyses and independent sample t-test were used for statistical assessment.

RESULTS

The mean score of HADS-anxiety score prior to MPS was 8.1 ± 4.2, whereas the mean HADS depression score was 6.1 ± 3.7. The mean state anxiety score prior to MPS was 39.7 ± 10.6 and the mean trait anxiety score was 45.02 ± 9.1. HAD and state and trait anxiety scores were found to be significantly higher in female patients than male patients and non-smoker patients than smoker patients. Other risk factors such as having bypass operation, myocardial infarction, hypercholesterolemia, diabetes and hypertension were not related to depression and anxiety scores.

CONCLUSION

The results in this study suggest a role for MPS as a risk factor for higher state anxiety. The MPS procedures might lead to an increase in anxiety levels of patients which is possibly associated with anticipation anxiety felt during waiting period and expectation life-threatening.