Psychosocial variables, age, and angiographically-determined coronary artery disease in women

Association of Anxiety and Depression in Patients Undergoing Cardiac Catheterization With Number of Major Coronary Artery Stenosis: A Cross-Sectional Study

Introduction

The relationship between the level of anxiety and depression among coronary artery disease (CAD) patients and coronary angiographic findings is ambiguously mentioned in studies. Past evidence shows that the relationship between anxiety and depression with coronary artery disease can be bidirectional. There is a paucity of literature on the association of levels of anxiety and depression with the number of coronary arteries involved in coronary artery disease.

Methods

This study was conducted in a tertiary care hospital to find the level of anxiety and depression in patients undergoing cardiac catheterization and their association with the numbers of the major coronary artery involved. Patients undergoing cardiac catheterization in the Department of Cardiovascular Science of a tertiary care hospital in India from May 2020 to December 2020 were considered for inclusion in the study. Coronary artery disease was diagnosed based on the combination of clinical, ECG, echocardiography, or biomarker parameters in various combinations. These patients were further subjected to coronary angiogram to know the extent of stenosis and the number of coronary vessels involved in the disease. The level of anxiety and depression was measured by using the Hospital Anxiety and Depression Scale (HADS) during the period of admission and at least 24 hours after diagnosis and at least 12 hours before cardiac catheterization. The data was entered into SPSS software version 22.0 (Armonk, NY: IBM Corp.) for statistical analysis. Chi-square test, Kolmogorov-Smirnov test, and Kruskal-Wallis test were used for the interpretation of data and find an association between severity of anxiety and depression with the number of major coronary vessels involved.

Results

Anxiety was seen in 83.3% of the patients with 31.5% having severe anxiety. Depression was found in 77.8% with 38.9% suffering from severe depression. The anxiety and depression scores of HADS were significantly higher in those with triple-vessel disease compared to the double-vessel or single-vessel disease.

Conclusion

Screening and management of anxiety and depression is an essential part of the care of patients with coronary artery disease. People with triple-vessel disease need the most attention and appropriate management of anxiety and depression.

Psychosocial Antecedents of Hostility in Persons with Coronary Heart Disease

Although it is known that hostility precedes coronary heart disease (CHD), little is known about factors that influence the development and progression of hostile characteristics. The relations among hostility, self-esteem, self-concept, and psychosocial residual were conceptualized within the modeling and role-modeling theoretical framework and examined in a sample of 85 persons with CHD. There were significant associations between all variables. Regression analyses revealed that self-esteem, mistrust residual, isolation residual, and self-concept contributed significantly, accounting for 31% of the variation in hostility scores. These findings provide support for the belief that the development of hostility in persons with CHD is related to beliefs and attitudes about the self and others. Persons with self-esteem need deficits, and a subsequent build up of negative psychosocial residual, have poor self-concepts. This poor self-concept is hostile in nature and reflects a mistrust of others and a deep sense of isolation.

Emotion Risk-Factor in Patients with Cardiac Diseases: The Role of Cognitive Emotion Regulation Strategies, Positive Affect and Negative Affect (A Case-Control Study)

Application of psychological interventions is essential in classic treatments for patient with cardiac diseases. The present study compared cognitive emotion regulation strategies, positive affect, and negative affect for cardiac patients with healthy subjects. This study was a case-control study. Fifty subjects were selected using convenient sampling method from cardiac (coronary artery disease) patients presenting in Imam Ali medical center of Kermanshah, Iran in the spring 2013. Fifty subjects accompanied the patients to the medical center, selected as control group, did not have any history of cardiac diseases. For collecting data, the cognitive emotion regulation questionnaire and positive and negative affect scales were used. For data analysis, multivariate analysis of variance (MANOVA) was applied using the SPSS statistical software (ver. 19.0). In all cognitive emotion regulation strategies, there was a significant difference between the two groups. A significant difference was also detected regarding positive affect between the two groups, but no significant difference was found regarding negative affect. We found as a result that, having poor emotion regulation strategies is a risk factor for developing heart diseases.

Relationship between depression and C-reactive protein in a screening population

BACKGROUND

Both depression and C-reactive protein (CRP) are markers of increased risk for cardiovascular events. This study examined the relationship between CRP and depression in a cohort of participants undergoing a periodic physical to assess potential for interaction as either mediation or confounding of effect on cardiovascular risk.

METHODS

We conducted a cross-sectional study of a cohort of 696 consenting, active duty US Army personnel undergoing a periodic physical. We measured depression using the Patient Health Questionnaire-9, the depression module of the self-administered version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). We used a highly sensitive assay to measure CRP.

RESULTS

The mean age in the cohort was 44 years (SD +/- 3; 82% male). The mean CRP level was 1.7 mg/l (range, 0.3-9.9; SD +/- 1.6 mg/l). Depression scores ranged from 0 to 26 with a mean of 2 (SD +/- 3). Depression scores correlated with prevalences of major depressive disorder and of any depressive disorder of 3.3% and 15%, respectively. Depression scores correlated positively with CRP levels (r = 0.085; p =.028), as did other variables known to be associated with CRP: body mass index (BMI; r = 0.36), insulin levels (r = 0.22), mean arterial pressure (r = 0.21), triglycerides (r = 0.18), exercise (r = -0.12), female sex (r = 0.097), current smoking status (r = 0.08), and high density lipoprotein (r = -0.09). After controlling only for BMI, the relationship between depression and CRP lost statistical significance among women (adjusted r = 0.08; p =.37), among men (adjusted r = -0.11; p =.8), and overall (adjusted r = 0.047; p =.219).

CONCLUSION

Depressive symptoms are only weakly correlated with CRP. However, after adjusting for BMI, we found no significant relationship between CRP and depression. The relationship between depression and clinical coronary disease is unlikely to be explained through direct effects on CRP levels, but may be mediated by BMI.

Relation between type A behavior pattern and the extent of coronary atherosclerosis in Japanese women

This study examined the relation of Type A behavior pattern and its components to angiographically documented coronary atherosclerosis in 198 Japanese women. A questionnaire-based interview elicited psychosocial and other factors. Type A behavior pattern was measured by 12 questions. Significant coronary stenosis was defined when a 75% or greater luminal narrowing occurred at one or more major coronary arteries or 50% or greater narrowing occurred at the left main artery. Gensini's score also was calculated. Logistic regression analysis was used to calculate odds ratios and 95% confidence intervals with adjustment for traditional coronary risk factors and the presence of a job. Global Type A behavior pattern showed no material association with the severity of coronary atherosclerosis assessed by both Gensini's score and the presence of significant coronary stenosis. However, its subcomponents, enthusiasm and competitiveness, were positively related to the severity of coronary atherosclerosis, whereas self-confidence and perfectionism were negatively related. These findings suggest overall a null association between global Type A and coronary atherosclerosis as well as the presence of toxic or beneficial components of Type A behaviors in Japanese women.

Development and cross-cultural and clinical validation of a brief comprehensive scale for assessing hostility in medical settings

This study presents the development and validation of a brief comprehensive hostility scale. Two items of each subscale from the Buss-Perry (1992) Aggression Questionnaire, most strongly correlated with their subscale score, were selected, yielding the eight-item New-Buss. Internal reliability was .66 to .81, and full and brief scales correlated r = .92 to .94. In Study 1 (95 Israeli students), New-Buss scores were significantly higher in self-rated deviant or speeding drivers than nondeviant or nonspeeding drivers, respectively. In Study 2 (279 American students), New-Buss scores correlated significantly with Barefoot's Ho, Anger-Out, Anger-In, and Agreeableness. In Study 3 (79 Israeli patients undergoing angiography), New-Buss scores were significantly correlated with coronary artery disease severity independent of SBP in men below age 60 alone but not in women. Our findings support the cross-cultural feasibility, reliability, and concurrent, construct, and criterion validity of the New-Buss.

Lack of correlation between psychological factors and subclinical coronary artery disease

BACKGROUND

The relation between psychological variables and clinically evident coronary artery disease has been studied extensively, although the potential mechanisms of such a relation remain speculative. We studied the relation between multiple psychological variables and subclinical coronary artery disease to assess the possible role of such variables in atherogenesis.

METHODS

We conducted a prospective study of 630 consecutive consenting, active-duty U.S. Army personnel, 39 to 45 years of age, without known coronary artery disease. Each participant was assessed for depression, anxiety, somatization, hostility, and stress. Subclinical coronary artery disease was identified by electron-beam computed tomography.

RESULTS

The mean (+/-SD) age of the subjects was 42+/-2 years; 82 percent were male, and 72 percent were white. The prevalence of coronary-artery calcification was 17.6 percent (mean calcification score, 10+/-49). The prevalence of prior or current psychiatric disorders was 12.7 percent. There was no correlation between the coronary-calcification score and the scores measuring depression (r= -0.07, P=0.08), anxiety (r=-0.07, P=0.10), hostility (r=-0.07, P=0.10), or stress (r=-0.002, P=0.96). Somatization (the number and severity of durable physical symptoms) was inversely correlated with calcification scores (r=-0.12, P=0.003), even after we controlled for age and sex. In multivariate logistic-regression models, a somatization score greater than 4 (out of a possible 26) was independently associated with the absence of any coronary-artery calcification (odds ratio, 0.49; 95 percent confidence interval, 0.25 to 0.96).

CONCLUSIONS

Our data suggest that depression, anxiety, hostility, and stress are not related to coronary-artery calcification and that somatization is associated with the absence of calcification.