1
|
Assaf M, Costa D, Massag J, Weber C, Mikolajczyk R, Lückmann SL. Comparison between In-Hospital and Out-of-Hospital Acute Myocardial Infarctions: Results from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA) Study. J Clin Med 2023; 12:6305. [PMID: 37834949 PMCID: PMC10573894 DOI: 10.3390/jcm12196305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
AIMS Risk factors and outcomes of in-hospital ST elevation myocardial infraction (STEMI) are well explored. Recent findings show that non-ST elevation myocardial infarction (NSTEMI) accounts for the majority of in-hospital infarctions (IHMIs). Our aim was to identify differences between IHMI and out-of-hospital myocardial infraction (OHMI) in terms of risk factors, treatment and outcomes, including both STEMI and NSTEMI. METHODS We analyzed the Regional Myocardial Infarction Registry of Saxony-Anhalt dataset. Patient characteristics, treatments and outcomes were compared between IHMI and OHMI. The association between clinical outcomes and myocardial infarction type was assessed using generalized additive models. RESULTS Overall, 11.4% of the included myocardial infractions were IHMI, and the majority were NSTEMI. Patients with IHMI were older and had more comorbidities than those with OHMI. Compared to OHMI, in-hospital myocardial infarction was associated with higher odds of 30-day mortality (OR = 1.85, 95% CI 1.32-2.59) and complications (OR = 2.36, 95 % CI 1.84-3.01). CONCLUSIONS We provided insights on the full spectrum of IHMI, in both of its classifications. The proportion of IHMI was one ninth of all AMI cases treated in the hospital. Previously reported differences in the baseline characteristics and treatments, as well as worse clinical outcomes, in in-hospital STEMI compared to out-of-hospital STEMI persist even when including NSTEMI cases.
Collapse
Affiliation(s)
| | | | | | | | | | - Sara Lena Lückmann
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle, Germany; (M.A.)
| |
Collapse
|
2
|
Chen X, Xu L, Li Z. Autonomic Neural Circuit and Intervention for Comorbidity Anxiety and Cardiovascular Disease. Front Physiol 2022; 13:852891. [PMID: 35574459 PMCID: PMC9092179 DOI: 10.3389/fphys.2022.852891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
Anxiety disorder is a prevalent psychiatric disease and imposes a significant influence on cardiovascular disease (CVD). Numerous evidence support that anxiety contributes to the onset and progression of various CVDs through different physiological and behavioral mechanisms. However, the exact role of nuclei and the association between the neural circuit and anxiety disorder in CVD remains unknown. Several anxiety-related nuclei, including that of the amygdala, hippocampus, bed nucleus of stria terminalis, and medial prefrontal cortex, along with the relevant neural circuit are crucial in CVD. A strong connection between these nuclei and the autonomic nervous system has been proven. Therefore, anxiety may influence CVD through these autonomic neural circuits consisting of anxiety-related nuclei and the autonomic nervous system. Neuromodulation, which can offer targeted intervention on these nuclei, may promote the development of treatment for comorbidities of CVD and anxiety disorders. The present review focuses on the association between anxiety-relevant nuclei and CVD, as well as discusses several non-invasive neuromodulations which may treat anxiety and CVD.
Collapse
Affiliation(s)
- Xuanzhao Chen
- The Center of Pathological Diagnosis and Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Li Xu
- Department of Rheumatology and Immunology, General Hospital of Central Theater Command, Wuhan, China
| | - Zeyan Li
- The Center of Pathological Diagnosis and Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| |
Collapse
|
3
|
Riordan P, Davis M. Anxiety and psychological management of heart disease and heart surgery. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:393-408. [PMID: 33632455 DOI: 10.1016/b978-0-12-819814-8.00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anxiety is associated with many forms and facets of heart disease, and, by extension, neurologic manifestations of heart disease. Despite its seeming self-evidence, anxiety is challenging to consistently define, measure, and operationalize in the context of medical research. Various diagnostic nosologies have been defined and refined over time, but anxiety is also a universal human experience that may be "normal" in many circumstances, particularly in the face of major medical issues. For these and other reasons, the research on anxiety and heart disease is mixed, incomplete, and often characterized by challenging questions of causality. Nonetheless, a broad body of literature has established clear connections between anxiety and vascular risk factors, cardiac disease, and cardiac surgery. These relationships are often intuitive, with research suggesting, for example, that chronic activation of the sympathetic nervous system is associated with increased risk of heart disease. However, they are sometimes complexly reciprocal or even surprising (e.g., with high-anxiety individuals found to have better outcomes in some cardiac conditions by virtue of seeking evaluation and treatment earlier). This chapter reviews the construct of anxiety and its complexities, its associations with heart disease, and the established treatments for anxiety, concluding with questions about anxiety, heart disease, and their optimal management that still need to be answered.
Collapse
Affiliation(s)
- Patrick Riordan
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States.
| | - Matthew Davis
- Mental Health Service Line, Edward Hines Jr. VA Hospital, Hines, IL, United States
| |
Collapse
|
4
|
Afsin A, Asoğlu R, Orum MH, Cicekci E. Evaluation of TP-E Interval and TP-E/QT Ratio in Panic Disorder. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E215. [PMID: 32353958 PMCID: PMC7279486 DOI: 10.3390/medicina56050215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: The autonomic nervous system (ANS) is involved in panic disorders. ANS dysfunction has been shown to be associated with ventricular arrhythmia and increased heterogeneity of ventricular repolarization. However, there remains limited evidence of the relationship between panic disorders and ventricular depolarization markers, including the Tp-e interval and Tp-e/QT ratio. This study aimed to evaluate ventricular repolarization parameters in patients with panic disorder. Materials and Methods: In total, 40 patients with panic disorder, diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, were included in the study group. The control group comprised of 50 age- and sex-matched healthy individuals. A standard 12 lead electrocardiogram was recorded on all participants, and heart rate, QT interval, QRS duration, Tp-e interval, and Tp-e/QT ratio were measured. Results: QRS durations and QT intervals were similar in the study and control groups. Compared to the control group, QTd, Tp-e, and cTp-e intervals as well as Tp-e/QT and Tp-e/QTc ratios were significantly increased in patients with panic disorder (p < 0.05 for all). In the study group, the Severity Measure for Panic Disorder-Adult score had a significant positive correlation with the Tp-e interval (r = 0.369, p < 0001), cTp-e interval (r = 0.531, p < 0.001), Tp-e/QT ratio (r = 0.358, p = 0.001), and Tp-e/QTc ratio (r = 0.351, p = 0.001). Conclusion: These findings indicate that panic disorders are associated with increased ventricular repolarization heterogeneity, which may be attributed to ANS dysregulation.
Collapse
Affiliation(s)
- Abdulmecit Afsin
- Department of Cardiology, M.D, Kahta State Hospital, Adıyaman 02450, Turkey
| | - Ramazan Asoğlu
- Department of Cardiology, M.D, Adıyaman Training and Research Hospital, Adıyaman 02450, Turkey;
| | - Mehmet Hamdi Orum
- Department of Psychiatry, M.D, Kahta State Hospital, Adıyaman 02450, Turkey; (M.H.O.); (E.C.)
| | - Elvan Cicekci
- Department of Psychiatry, M.D, Kahta State Hospital, Adıyaman 02450, Turkey; (M.H.O.); (E.C.)
| |
Collapse
|
5
|
Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
Collapse
Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| |
Collapse
|
6
|
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Identify the relationships between depression, anxiety, and heart failure (HF).• Assess methods for accurately diagnosing depression and anxiety disorders in patients with HF.• Evaluate current evidence for treatment of anxiety and depression in patients with HF. BACKGROUND In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes such as reduced adherence to treatment, poor function, increased hospitalizations, and elevated mortality. Despite the adverse impact of these disorders, anxiety and depression remain underdiagnosed and undertreated in HF patients. METHODS We performed a targeted literature review to (1) identify associations between depression, anxiety, and HF, (2) examine mechanisms mediating relationships between these conditions and medical outcomes, (3) identify methods for accurately diagnosing depression and anxiety disorders in HF, and (4) review current evidence for treatments of these conditions in this population. RESULTS Both depression and anxiety disorders are associated with the development and progression of HF, including increased rates of mortality, likely mediated through both physiologic and behavioral mechanisms. Given the overlap between cardiac and psychiatric symptoms, accurately diagnosing depression or anxiety disorders in HF patients can be challenging. Adherence to formal diagnostic criteria and utilization of a clinical interview are the best courses of action in the evaluation process. There is limited evidence for the efficacy of pharmacologic and psychotherapy in patients with HF. However, cognitive-behavioral therapy has been shown to improve mental health outcomes in patients with HF, and selective serotonin reuptake inhibitors appear safe in this cohort. CONCLUSIONS Depression and anxiety disorders in HF patients are common, underrecognized, and linked to adverse outcomes. Further research to improve detection and develop effective treatments for these disorders in HF patients is badly needed.
Collapse
Affiliation(s)
- Christopher M. Celano
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Ana C. Villegas
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Hanna K. Gaggin
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Jeff C. Huffman
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
7
|
Abstract
Currently, panic disorder (PD) is considered a mental disorder based on the assumptions that panic attacks (PAs) are “false alarms” that arise from abnormally sensitive defense systems in the central nervous system and that PD is treated with therapies specifically acting on anxiety or fear mechanisms. This article aims to propose an alternative perspective based on the results of some experimental studies. Our heuristic proposal suggests not only that PD may be a mental disorder but also that patients with PD have real abnormal body functioning, mainly involving cardiorespiratory and balance systems, leading to a decline in global physical fitness. PAs, as well as physical symptoms or discomfort in some environmental situations, may be “real alarms” signaling that the adaptability resources of an organism are insufficient to respond appropriately to some internal or external changes, thus representing the transient conscious awareness of an imbalance in body functioning. The antipanic properties of several modern treatments for PD may include their beneficial effects on body functions. Although anxiety or fear mechanisms are evidently involved in PD, we hypothesize that a reduction of physical fitness is the “primum movens” of PD, while anxiety or fear is induced and sustained by repeated signals of impaired body functioning. We propose considering panic in a broader perspective that offers a central role to the body and to contemplate the possible role of somatic treatments in PD.
Collapse
Affiliation(s)
- Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami, USA
| | - Daniela Caldirola
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy
| |
Collapse
|
8
|
Abstract
Unrecognized anxiety is a difficult clinical presentation in cardiology. Anxiety leads to recurring emergency department visits and the need for numerous diagnostic evaluations to rule out cardiovascular disease (CVD). This review focuses broadly on anxiety and its subtypes in relation to the onset and progression of CVD while describing helpful guidelines to better identify and treat anxiety. Potential mechanisms of cardiopathogenesis are also described. An emerging literature demonstrates that anxiety disorders increase the risk for incident CVD but a causal relationship has not been demonstrated. Anxiety portends adverse prognosis in persons with established CVD that is independent from depression. The level of clinical priority received by depression should be extended to research and clinical intervention efforts in anxiety. Anxiety holds direct relevance for uncovering mechanisms of cardiopathogenesis, developing novel therapeutic strategies, and initiating clinical interventions in the population at risk of developing heart disease, or those already diagnosed with CVD.
Collapse
Affiliation(s)
- Phillip J Tully
- Bordeaux Population Health, University of Bordeaux, U1219, Bordeaux, France. .,Freemasons Foundation Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, Australia. .,INSERM U1219, Université de Bordeaux, 146 rue Léo Saignat - Case 11, 33076, Bordeaux Cedex, France.
| | - Nathan J Harrison
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, Australia.,Department of Cardiology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Peter Cheung
- Department of Cardiology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Suzanne Cosh
- Bordeaux Population Health, University of Bordeaux, U1219, Bordeaux, France
| |
Collapse
|
9
|
Atkinson MD, Kennedy JI, John A, Lewis KE, Lyons RA, Brophy ST. Development of an algorithm for determining smoking status and behaviour over the life course from UK electronic primary care records. BMC Med Inform Decis Mak 2017; 17:2. [PMID: 28056955 PMCID: PMC5217540 DOI: 10.1186/s12911-016-0400-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Patients’ smoking status is routinely collected by General Practitioners (GP) in UK primary health care. There is an abundance of Read codes pertaining to smoking, including those relating to smoking cessation therapy, prescription, and administration codes, in addition to the more regularly employed smoking status codes. Large databases of primary care data are increasingly used for epidemiological analysis; smoking status is an important covariate in many such analyses. However, the variable definition is rarely documented in the literature. Methods The Secure Anonymised Information Linkage (SAIL) databank is a repository for a national collection of person-based anonymised health and socio-economic administrative data in Wales, UK. An exploration of GP smoking status data from the SAIL databank was carried out to explore the range of codes available and how they could be used in the identification of different categories of smokers, ex-smokers and never smokers. An algorithm was developed which addresses inconsistencies and changes in smoking status recording across the life course and compared with recorded smoking status as recorded in the Welsh Health Survey (WHS), 2013 and 2014 at individual level. However, the WHS could not be regarded as a “gold standard” for validation. Results There were 6836 individuals in the linked dataset. Missing data were more common in GP records (6%) than in WHS (1.1%). Our algorithm assigns ex-smoker status to 34% of never-smokers, and detects 30% more smokers than are declared in the WHS data. When distinguishing between current smokers and non-smokers, the similarity between the WHS and GP data using the nearest date of comparison was κ = 0.78. When temporal conflicts had been accounted for, the similarity was κ = 0.64, showing the importance of addressing conflicts. Conclusions We present an algorithm for the identification of a patient’s smoking status using GP self-reported data. We have included sufficient details to allow others to replicate this work, thus increasing the standards of documentation within this research area and assessment of smoking status in routine data. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0400-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mark D Atkinson
- Farr Institute, Swansea University Medical School, Swansea, SA2 8PP, UK.
| | | | - Ann John
- Farr Institute, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - Keir E Lewis
- Farr Institute, Swansea University Medical School, Swansea, SA2 8PP, UK.,Prince Philip Hospital, Hywel Dda Health Board, Llanelli, UK
| | - Ronan A Lyons
- Farr Institute, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - Sinead T Brophy
- Farr Institute, Swansea University Medical School, Swansea, SA2 8PP, UK
| | | |
Collapse
|
10
|
Celano CM, Villegas A, Albanese A, Huffman JC. Heart Failure: Psychological and Pharmacological Considerations. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20161102-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
11
|
Abstract
Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. Anxiety disorders are associated with the onset and progression of cardiac disease, and in many instances have been linked to adverse cardiovascular outcomes, including mortality. Both physiologic (autonomic dysfunction, inflammation, endothelial dysfunction, changes in platelet aggregation) and health behavior mechanisms may help to explain the relationships between anxiety disorders and cardiovascular disease. Given the associations between anxiety disorders and poor cardiac health, the timely and accurate identification and treatment of these conditions is of the utmost importance. Fortunately, pharmacologic and psychotherapeutic interventions for the management of anxiety disorders are generally safe and effective. Further study is needed to determine whether interventions to treat anxiety disorders ultimately impact both psychiatric and cardiovascular health.
Collapse
|
12
|
Meta-Analysis of Anxiety as a Risk Factor for Cardiovascular Disease. Am J Cardiol 2016; 118:511-9. [PMID: 27324160 DOI: 10.1016/j.amjcard.2016.05.041] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 11/22/2022]
Abstract
Whether anxiety is a risk factor for a range of cardiovascular diseases is unclear. We aimed to determine the association between anxiety and a range of cardiovascular diseases. MEDLINE and EMBASE were searched for cohort studies that included participants with and without anxiety, including subjects with anxiety, worry, posttraumatic stress disorder, phobic anxiety, and panic disorder. We examined the association of anxiety with cardiovascular mortality, major cardiovascular events (defined as the composite of cardiovascular death, stroke, coronary heart disease, and heart failure), stroke, coronary heart disease, heart failure, and atrial fibrillation. We identified 46 cohort studies containing 2,017,276 participants and 222,253 subjects with anxiety. Anxiety was associated with a significantly elevated risk of cardiovascular mortality (relative risk [RR] 1.41, CI 1.13 to 1.76), coronary heart disease (RR 1.41, CI 1.23 to 1.61), stroke (RR 1.71, CI 1.18 to 2.50), and heart failure (RR 1.35, CI 1.11 to 1.64). Anxiety was not significantly associated with major cardiovascular events or atrial fibrillation although CIs were wide. Phobic anxiety was associated with a higher risk of coronary heart disease than other anxiety disorders, and posttraumatic stress disorder was associated with a higher risk of stroke. Results were broadly consistent in sensitivity analyses. Anxiety disorders are associated with an elevated risk of a range of different cardiovascular events, including stroke, coronary heart disease, heart failure, and cardiovascular death. Whether these associations are causal is unclear.
Collapse
|
13
|
Muka T, Oliver-Williams C, Colpani V, Kunutsor S, Chowdhury S, Chowdhury R, Kavousi M, Franco OH. Association of Vasomotor and Other Menopausal Symptoms with Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0157417. [PMID: 27315068 PMCID: PMC4912069 DOI: 10.1371/journal.pone.0157417] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/31/2016] [Indexed: 01/11/2023] Open
Abstract
Importance Vasomotor symptoms (hot flushes and night sweats) and other symptoms, including depression, anxiety and panic attacks, are commonly experienced by menopausal women and have been associated with an unfavourable cardiovascular risk profile. Objective To investigate whether presence of menopausal symptoms is associated with the development of cardiovascular disease (CVD). Methods Five electronic databases (Medline, EMBASE and Web of Science) were search until February 17th, 2015 to identify relevant studies. Observational cohort studies or randomised intervention studies were eligible for inclusion if they followed participants prospectively (at least 1 year of follow-up), and reported relevant estimates on the association of any vasomotor symptoms, or other menopausal symptoms, with risk of CVD, coronary heart disease (CHD), or stroke in perimenopausal, menopausal, or postmenopausal women. Data were extracted by two independent reviewers using a pre-designed data collection form. Separate pooled relative risks (RRs) for age and non-established cardiovascular risk factors (e.g., education, ethnicity) adjusted data and for established cardiovascular risk factors and potential mediators-adjusted data (e.g., smoking, body mass index, and hypertension) were calculated. Results Out of 9,987 initially identified references, ten studies were selected, including 213,976 women with a total of 10,037 cardiovascular disease outcomes. The age and non-established cardiovascular risk factors adjusted RRs) [95% confidence intervals] for development of CHD, Stroke and CVD comparing women with and without any menopausal symptoms were 1.34 [1.13–1.58], 1.30 [0.99–1.70], 1.48 [1.21–1.80] respectively, and the corresponding RRs adjusted for cardiovascular risk factors and potential mediators were 1.18 [1.03–1.35], 1.08 [0.89–1.32], 1.29 [0.98–1.71]. However, these analyses were limited by potential unmeasured confounding and the small number of studies on this topic. Conclusion Presence of vasomotor symptoms and other menopausal symptoms are generally associated with an increased risk of cardiovascular disease, which is mainly explained by cardiovascular risk factors.
Collapse
Affiliation(s)
- Taulant Muka
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Clare Oliver-Williams
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Veronica Colpani
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Setor Kunutsor
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Susmita Chowdhury
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Rajiv Chowdhury
- Department of Public Health & Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
14
|
Batelaan NM, Seldenrijk A, Bot M, van Balkom AJLM, Penninx BWJH. Anxiety and new onset of cardiovascular disease: critical review and meta-analysis. Br J Psychiatry 2016; 208:223-31. [PMID: 26932485 DOI: 10.1192/bjp.bp.114.156554] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Anxiety has been associated with new-onset cardiovascular disease (CVD), but the quality of this relationship is unclear. Only if anxiety is a causal, independent cardiovascular risk factor might it be a target for CVD prevention. AIMS To determine and examine the independent association and causality between anxiety and incident CVD. METHOD PubMed, EMBASE and PsycINFO databases were searched up to October 2013. A review of Hill's criteria for causality and random effects meta-analysis were conducted of prospective, population-based studies examining anxiety and incident CVD in people free from CVD at baseline. RESULTS The meta-analysis comprised 37 papers (n = 1 565 699). The follow-up ranged from 1 to 24 years. Anxiety was associated with a 52% increased incidence of CVD (hazard ratio = 1.52, 95% CI 1.36-1.71). The risk seemed independent of traditional risk factors and depression. The evaluation of Hill's criteria largely argued in favour of causality. CONCLUSIONS Anxiety may be of interest for CVD prevention. Future research should examine biological and behavioural underpinnings of the association in order to identify targets for intervention.
Collapse
Affiliation(s)
- Neeltje M Batelaan
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Adrie Seldenrijk
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mariska Bot
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Gottschalk MG, Cooper JD, Chan MK, Bot M, Penninx BWJH, Bahn S. Serum biomarkers predictive of depressive episodes in panic disorder. J Psychiatr Res 2016; 73:53-62. [PMID: 26687614 DOI: 10.1016/j.jpsychires.2015.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/13/2015] [Accepted: 11/20/2015] [Indexed: 01/30/2023]
Abstract
Panic disorder with or without comorbid agoraphobia (PD/PDA) has been linked to an increased risk to develop subsequent depressive episodes, yet the underlying pathophysiology of these disorders remains poorly understood. We aimed to identify a biomarker panel predictive for the development of a depressive disorder (major depressive disorder and/or dysthymia) within a 2-year-follow-up period. Blood serum concentrations of 165 analytes were evaluated in 120 PD/PDA patients without depressive disorder baseline diagnosis (6-month-recency) in the Netherlands Study of Depression and Anxiety (NESDA). We assessed the predictive performance of serum biomarkers, clinical, and self-report variables using receiver operating characteristics curves (ROC) and the area under the ROC curve (AUC). False-discovery-rate corrected logistic regression model selection of serum analytes and covariates identified an optimal predictive panel comprised of tetranectin and creatine kinase MB along with patient gender and scores from the Inventory of Depressive Symptomatology (IDS) rating scale. Combined, an AUC of 0.87 was reached for identifying the PD/PDA patients who developed a depressive disorder within 2 years (n = 44). The addition of biomarkers represented a significant (p = 0.010) improvement over using gender and IDS alone as predictors (AUC = 0.78). For the first time, we report on a combination of biological serum markers, clinical variables and self-report inventories that can detect PD/PDA patients at increased risk of developing subsequent depressive disorders with good predictive performance in a naturalistic cohort design. After an independent validation our proposed biomarkers could prove useful in the detection of at-risk PD/PDA patients, allowing for early therapeutic interventions and improving clinical outcome.
Collapse
Affiliation(s)
- M G Gottschalk
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, UK
| | - J D Cooper
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, UK
| | - M K Chan
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, UK
| | - M Bot
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - S Bahn
- Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Cambridge, UK.
| |
Collapse
|
16
|
Tully PJ, Turnbull DA, Horowitz JD, Beltrame JF, Selkow T, Baune BT, Markwick E, Sauer-Zavala S, Baumeister H, Cosh S, Wittert GA. Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial. Trials 2016; 17:18. [PMID: 26754447 PMCID: PMC4707770 DOI: 10.1186/s13063-015-1109-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/08/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Previous psychological and pharmacological interventions have primarily focused on depression disorders in populations with cardiovascular diseases (CVDs) and the efficacy of anxiety disorder interventions is only more recently being explored. Transdiagnostic interventions address common emotional processes and the full range of anxiety and depression disorders often observed in populations with CVDs. The aim of CHAMPS is to evaluate the feasibility of a unified protocol (UP) for the transdiagnostic treatment of emotional disorders intervention in patients recently hospitalized for CVDs. The current study reports the protocol of a feasibility randomized controlled trial to inform a future trial. METHODS/DESIGN This is a feasibility randomized, controlled trial with a single-center design. A total of 50 participants will be block-randomized to either a UP intervention or enhanced usual care. Both groups will receive standard CVD care. The UP intervention consists of 1) enhancing motivation, readiness for change, and treatment engagement; (2) psychoeducation about emotions; (3) increasing present focused emotion awareness; (4) increasing cognitive flexibility; (5) identifying and preventing patterns of emotion avoidance and maladaptive emotion-driven behaviors (EDBs, including tobacco smoking, and alcohol use); (6) increasing tolerance of emotion-related physical sensations; (7) interoceptive and situation-based emotion-focused exposure; and (8) relapse prevention strategies. Treatment duration is 12 to 18 weeks. Relevant outcomes include the standard deviation of self-rated anxiety, depression and quality of life symptoms. Other outcomes include intervention acceptability, satisfaction with care, rates of EDBs, patient adherence, physical activity, cardiac and psychiatric readmissions. Parallel to the main trial, a nonrandomized comparator cohort will be recruited comprising 150 persons scoring below the predetermined depression and anxiety severity thresholds. DISCUSSION CHAMPS is designed to evaluate the UP for the transdiagnostic treatment of emotional disorders targeting emotional disorder processes in a CVD population. The design will provide preliminary evidence of feasibility, attrition, and satisfaction with treatment to design a definitive trial. If the trial is feasible, it opens up the possibility for interventions to target broader emotional processes in the precarious population with CVD and emotional distress. TRIAL REGISTRATION ACTRN12615000555550 , registered on 29/05/2015.
Collapse
Affiliation(s)
- Phillip J Tully
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany.
- INSERM, U897-Epidemiology and Biostatistics, Bordeaux, France.
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - Deborah A Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia.
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - John F Beltrame
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - Terina Selkow
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - Bernhard T Baune
- Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia.
| | - Elizabeth Markwick
- Department of Psychiatry, The Queen Elizabeth Hospital, Woodville West, Australia.
| | - Shannon Sauer-Zavala
- Center for Anxiety & Related Disorders, Department of Psychology, Boston University, Boston, USA.
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany.
| | - Suzanne Cosh
- School of Psychology, The University of Adelaide, Adelaide, Australia.
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| |
Collapse
|
17
|
Tully PJ, Turnbull DA, Beltrame J, Horowitz J, Cosh S, Baumeister H, Wittert GA. Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1131612 persons and 58111 cardiac events. Psychol Med 2015; 45:2909-2920. [PMID: 26027689 DOI: 10.1017/s0033291715000963] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Substantial healthcare resources are devoted to panic disorder (PD) and coronary heart disease (CHD); however, the association between these conditions remains controversial. Our objective was to conduct a systematic review of studies assessing the association between PD, related syndromes, and incident CHD. METHOD Relevant studies were retrieved from Medline, EMBASE, SCOPUS and PsycINFO without restrictions from inception to January 2015 supplemented with hand-searching. We included studies that reported hazard ratios (HR) or sufficient data to calculate the risk ratio and 95% confidence interval (CI) which were pooled using a random-effects model. Studies utilizing self-reported CHD were ineligible. Twelve studies were included comprising 1 131 612 persons and 58 111 incident CHD cases. RESULTS PD was associated with the primary incident CHD endpoint [adjusted HR (aHR) 1.47, 95% CI 1.24-1.74, p < 0.00001] even after excluding angina (aHR 1.49, 95% CI 1.22-1.81, p < 0.00001). High to moderate quality evidence suggested an association with incident major adverse cardiac events (MACE; aHR 1.40, 95% CI 1.16-1.69, p = 0.0004) and myocardial infarction (aHR 1.36, 95% CI 1.12-1.66, p = 0.002). The risk for CHD was significant after excluding depression (aHR 1.64, 95% CI 1.45-1.85) and after depression adjustment (aHR 1.38, 95% CI 1.03-1.87). Age, sex, length of follow-up, socioeconomic status and diabetes were sources of heterogeneity in the primary endpoint. CONCLUSIONS Meta-analysis showed that PD was independently associated with incident CHD, myocardial infarction and MACE; however, reverse causality cannot be ruled out and there was evidence of heterogeneity.
Collapse
Affiliation(s)
- P J Tully
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - D A Turnbull
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - J Beltrame
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - J Horowitz
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - S Cosh
- Clinic of Psychiatry and Psychotherapy II,University of Ulm,Gunzburg,Germany
| | - H Baumeister
- Department of Rehabilitation Psychology and Psychotherapy,Institute of Psychology,University of Freiburg,Germany
| | - G A Wittert
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| |
Collapse
|
18
|
Alosco ML, Gunstad J, Beard C, Xu X, Clark US, Labbe D, Jerskey BA, Ladino M, Cote D, Walsh E, Poppas A, Cohen RA, Sweet LH. The synergistic effects of anxiety and cerebral hypoperfusion on cognitive dysfunction in older adults with cardiovascular disease. J Geriatr Psychiatry Neurol 2015; 28:57-66. [PMID: 25009160 PMCID: PMC4289129 DOI: 10.1177/0891988714541871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Anxiety is a risk factor for cardiovascular disease (CVD) and is associated with neurocognitive outcomes. The effect of anxiety on brain perfusion in a CVD population has yet to be examined, and no study has investigated the interactive effects of anxiety and cerebral perfusion on cognition. METHODS A total of 55 older adults with CVD completed the Beck Anxiety Inventory (BAI) and underwent arterial spin labeling to quantify cortical perfusion and thickness. Participants were administered the Mini-Mental State Examination (MMSE) and the Repeatable Battery for the Assessment of Neuropsychological Status. RESULTS Reduced perfusion predicted poorer cognition and decreased cortical thickness. Higher anxiety score predicted worse memory performance and decreased frontal perfusion. Frontal lobe hypoperfusion combined with increased BAI scores exacerbated poorer MMSE performance. CONCLUSIONS Higher anxiety may exacerbate the effects of cerebral hypoperfusion on cognitive impairment. Longitudinal studies are needed to confirm our findings and determine whether anxiety treatment improves neurocognitive outcomes in CVD.
Collapse
Affiliation(s)
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, OH
| | | | - Xiaomeng Xu
- Department of Psychology, Idaho State University, Pocatello, ID
| | - Uraina S. Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | | | - Athena Poppas
- Brown University, Section of Cardiology, Providence, RI
| | | | - Lawrence H. Sweet
- Brown University, Providence, RI,Department of Psychology, University of Georgia, Athens, GA
| |
Collapse
|
19
|
Tully PJ, Cosh SM, Baumeister H. The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. J Psychosom Res 2014; 77:439-48. [PMID: 25455809 DOI: 10.1016/j.jpsychores.2014.10.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD. METHODS A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible). RESULTS Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio=1.94, 95% CI 1.45-2.60, P<.001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28-64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies. CONCLUSIONS The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.
Collapse
Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany.
| | - Suzanne M Cosh
- Clinic of Psychiatry and Psychotherapy II, University of Ulm, Gunzburg, Germany
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany
| |
Collapse
|
20
|
Welch CA, Petersen I, Bartlett JW, White IR, Marston L, Morris RW, Nazareth I, Walters K, Carpenter J. Evaluation of two-fold fully conditional specification multiple imputation for longitudinal electronic health record data. Stat Med 2014; 33:3725-37. [PMID: 24782349 PMCID: PMC4285297 DOI: 10.1002/sim.6184] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 01/08/2014] [Accepted: 04/03/2014] [Indexed: 12/02/2022]
Abstract
Most implementations of multiple imputation (MI) of missing data are designed for simple rectangular data structures ignoring temporal ordering of data. Therefore, when applying MI to longitudinal data with intermittent patterns of missing data, some alternative strategies must be considered. One approach is to divide data into time blocks and implement MI independently at each block. An alternative approach is to include all time blocks in the same MI model. With increasing numbers of time blocks, this approach is likely to break down because of co-linearity and over-fitting. The new two-fold fully conditional specification (FCS) MI algorithm addresses these issues, by only conditioning on measurements, which are local in time. We describe and report the results of a novel simulation study to critically evaluate the two-fold FCS algorithm and its suitability for imputation of longitudinal electronic health records. After generating a full data set, approximately 70% of selected continuous and categorical variables were made missing completely at random in each of ten time blocks. Subsequently, we applied a simple time-to-event model. We compared efficiency of estimated coefficients from a complete records analysis, MI of data in the baseline time block and the two-fold FCS algorithm. The results show that the two-fold FCS algorithm maximises the use of data available, with the gain relative to baseline MI depending on the strength of correlations within and between variables. Using this approach also increases plausibility of the missing at random assumption by using repeated measures over time of variables whose baseline values may be missing.
Collapse
Affiliation(s)
- Catherine A Welch
- Department of Primary Care and Population Health, University College London (UCL), London, U.K
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Marston L, Carpenter JR, Walters KR, Morris RW, Nazareth I, White IR, Petersen I. Smoker, ex-smoker or non-smoker? The validity of routinely recorded smoking status in UK primary care: a cross-sectional study. BMJ Open 2014; 4:e004958. [PMID: 24760355 PMCID: PMC4010810 DOI: 10.1136/bmjopen-2014-004958] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To investigate how smoking status is recorded in UK primary care; to evaluate whether appropriate multiple imputation (MI) of smoking status yields results consistent with health surveys. SETTING UK primary care and a population survey conducted in the community. PARTICIPANTS We identified 354 204 patients aged 16 or over in The Health Improvement Network (THIN) primary care database registered with their general practice 2008-2009 and 15 102 individuals aged 16 or over in the Health Survey for England (HSE). OUTCOME MEASURES Age-standardised and age-specific proportions of smokers, ex-smokers and non-smokers in THIN and the HSE before and after MI. Using information on time since quitting in the HSE, we estimated when ex-smokers are typically recorded as non-smokers in primary care records. RESULTS In THIN, smoking status was recorded for 84% of patients within 1 year of registration. Of these, 28% were smokers (21% in the HSE). After MI of missing smoking data, the proportion of smokers was 25% (missing at random) and 20% (missing not at random). With increasing age, more were identified as ex-smokers in the HSE than THIN. It appears that those who quit before age 30 were less likely to be recorded as an ex-smoker in primary care than people who quit later. CONCLUSIONS Smoking status was relatively well recorded in primary care. Misclassification of ex-smokers as non-smokers is likely to occur in those quitting smoking at an early age and/or a long time ago. Those with no smoking status information are more likely to be ex-smokers or non-smokers than smokers.
Collapse
Affiliation(s)
- Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - James R Carpenter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- MRC Clinical Trials Unit, London, UK
| | - Kate R Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Richard W Morris
- Department of Primary Care and Population Health, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ian R White
- MRC Biostatistics Unit, Cambridge Institute of Public Health, University Forvie Site, Cambridge, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
| |
Collapse
|
22
|
Voulgari C, Pagoni S, Tesfaye S, Tentolouris N. The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev 2014; 9:197-210. [PMID: 23909632 PMCID: PMC3780345 DOI: 10.2174/1573403x113099990031] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 03/19/2013] [Indexed: 12/14/2022] Open
Abstract
The ventricular gradient (VG) as a concept was conceived in the 1930s and its calculation yielded information that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand and its computation time-consuming. The contemporary spatial QRS-T angle is based on the concept of the VG and defined as its mathematical and physiological integral. Its current major clinical use is to assess the cardiac primary repolarization abnormalities in 3-dimensional spatial vectorial plans which are normally untraced in the presence of secondary electrophysiological activity in a 2-dimensional routine electrocardiogram (ECG). Currently the calculation of the spatial QRS-T angle can be easily computed on the basis of a classical ECG and contributes to localization of arrhythmogenic areas in the heart by assessing overall and local heterogeneity of the myocardial ventricular action potention duration. Recent population-based studies suggest that the spatial QRS-T angle is a dominant ECG predictor of future cardiovascular events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified primary and secondary cardiovascular prevention efforts and should be included in everyday clinical practice. This review addresses the nature and diagnostic potential of the spatial QRS-T angle. The main focus is its role in ECG assessment of dispersion of repolarization, a key factor in arrythmogeneity.
Collapse
Affiliation(s)
- Christina Voulgari
- First Department of Propaudeutic Internal Medicine, “Laiko” General Hospital, Athens University Medical School, Greece.
| | | | | | | |
Collapse
|
23
|
Batelaan NM, ten Have M, van Balkom AJLM, Tuithof M, de Graaf R. Anxiety disorders and onset of cardiovascular disease: the differential impact of panic, phobias and worry. J Anxiety Disord 2014; 28:252-8. [PMID: 24513159 DOI: 10.1016/j.janxdis.2013.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/06/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
Anxiety has been linked to onset of cardiovascular disease. This study examines the differential impact of types of anxiety (panic, phobia and worry) on 3-year onset of non-fatal cardiovascular disease (CVD). By investigating anxiety disorders as opposed to anxiety symptoms and by using a reliable diagnostic instrument to assess anxiety, limitations of previous studies are considered. 5149 persons at risk for CVD were interviewed using the Composite International Diagnostic Interview. The panic-type included panic disorder and panic attacks; the phobic-type included agoraphobia and social phobia, and the worry-type included generalized anxiety disorder. CVD was self-reported and required treatment or monitoring by a doctor. Analyses were adjusted for sociodemographics, behavioral variables, and comorbid somatic and psychiatric disorders. During follow-up, 62 persons (1.2%) developed CVD. Baseline generalized anxiety disorder was strongly associated with onset of CVD (adjusted OR: 3.39). Further research should replicate findings and focus on biological underpinnings of this association.
Collapse
Affiliation(s)
- Neeltje M Batelaan
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| |
Collapse
|
24
|
Gale CR, Batty GD, Osborn DPJ, Tynelius P, Rasmussen F. Mental disorders across the adult life course and future coronary heart disease: evidence for general susceptibility. Circulation 2014; 129:186-93. [PMID: 24190959 PMCID: PMC4107269 DOI: 10.1161/circulationaha.113.002065] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 09/25/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Depression, anxiety, and psychotic disorders have been associated with an increased risk of coronary heart disease (CHD). It is unclear whether this association between mental health and CHD is present across a wider range of mental disorders. METHODS AND RESULTS Participants were 1 107 524 Swedish men conscripted at a mean age of 18.3 years. Mental disorders were assessed by psychiatric interview on conscription, and data on hospital admissions for mental disorder and CHD were obtained from national registers during 22.6 years of follow-up. An increased risk of incident CHD was evident across a range of mental disorders whether diagnosed at conscription or on later hospital admission. Age-adjusted hazard ratios (95% confidence intervals) according to diagnoses at conscription ranged from 1.30 (1.05, 1.62) (depressive disorders) to 1.90 (1.58, 2.38) (alcohol-related disorders). [corrected]. The equivalent figures according to diagnoses during hospital admission ranged from 1.49 (1.24-1.80) (schizophrenia) to 2.82 (2.53-3.13) (other substance use disorders). Associations were little changed by adjustment for parental socioeconomic status, or body mass index, diabetes mellitus, and blood pressure measured at conscription, but they were partially attenuated by the adjustment for smoking, alcohol intake, and intelligence measured at conscription, and for education and own socioeconomic position. CONCLUSIONS Increased risk of incident CHD is present across a range of mental disorders and is observable when the disorders are diagnosed at a young age.
Collapse
Affiliation(s)
- Catharine R Gale
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK (C.R.G., G.D.B.); MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK (C.R.G.); Department of Epidemiology and Public Health, University College London, London, UK (G.D.B.); University College London Mental Health Sciences Unit, University College London, London, UK (D.P.J.O.); Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (P.T., F.R.); and Centre for Epidemiology and Community Medicine Stockholm County Council, Health Care Services, Stockholm, Sweden (P.T., F.R.)
| | | | | | | | | |
Collapse
|
25
|
Fleet R, Foldes-Busque G, Grégoire J, Harel F, Laurin C, Burelle D, Lavoie K. A study of myocardial perfusion in patients with panic disorder and low risk coronary artery disease after 35% CO2 challenge. J Psychosom Res 2014; 76:41-5. [PMID: 24360140 DOI: 10.1016/j.jpsychores.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND We have previously reported that 35% CO2 challenge induced myocardial ischemia in 81% of coronary artery disease (CAD) patients with comorbid panic disorder (PD) and previous positive nuclear exercise stress tests. However, it is yet unclear whether this is the case among CAD patients with PD and normal nuclear exercise stress test results. We hypothesized that a potent mental stressor such as a panic challenge among CAD patients with PD would also induce ischemia in patients with normal exercise stress tests. METHODS Forty-one coronary artery disease patients with normal nuclear exercise stress tests (21 patients with PD and 20 without PD) were submitted to a well-established panic challenge test (with 1 vital capacity inhalation of a gas mixture containing 35% CO2 and 65% O2) and injected with Tc-99m-tetrofosmin (Myoview), upon inhalation. Single photon emission computed tomography imaging was used to assess per-panic challenge reversible myocardial ischemia and HR, BP, and a 12 lead ECG was continuously measured during the procedure. RESULTS Fifty-eight percent of panic disorder patients (12/21) had a panic attack during the panic challenge vs 15% (3/20) of controls (p=0.005). Only 10% of patients in each group displayed myocardial ischemia per panic challenge. CONCLUSIONS These findings suggest that panic attacks among panic disorder patients with lower-risk coronary artery disease may not confer a risk for myocardial ischemia.
Collapse
Affiliation(s)
- Richard Fleet
- Department of Family Medicine Emergency Medicine, Université Laval, Quebec, Canada; Research Chair in Emergency Medicine, Université Laval-Hôtel-Dieu de Lévis, Quebec, Canada.
| | - Guillaume Foldes-Busque
- Research Chair in Emergency Medicine, Université Laval-Hôtel-Dieu de Lévis, Quebec, Canada; School of Psychology, Université Laval, Quebec, Canada
| | - Jean Grégoire
- School of Psychology, Université Laval, Quebec, Canada; Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Nuclear Medicine Service, Montreal Heart Institute, Montreal, Canada
| | - François Harel
- Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Nuclear Medicine Service, Montreal Heart Institute, Montreal, Canada
| | - Catherine Laurin
- Department of Medicine, Montreal Heart Institute, Montreal, Canada; Montreal Behavioural Medicine Centre, Research Centre, Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, affiliated with Université de Montréal, Montreal, Canada
| | - Denis Burelle
- Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | - Kim Lavoie
- Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Montreal Behavioural Medicine Centre, Research Centre, Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, affiliated with Université de Montréal, Montreal, Canada; Department of Psychology, Université du Québec à Montréal (UQAM), Montreal, Canada; Department of Psychology, University of Calgary, Alberta, Canada
| |
Collapse
|
26
|
Hedman E, Ljótsson B, Rück C, Bergström J, Andersson G, Kaldo V, Jansson L, Andersson E, Andersson E, Blom K, El Alaoui S, Falk L, Ivarsson J, Nasri B, Rydh S, Lindefors N. Effectiveness of internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care. Acta Psychiatr Scand 2013; 128:457-67. [PMID: 23406572 DOI: 10.1111/acps.12079] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Guided Internet-based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care. METHOD We conducted a cohort study investigating all patients (n = 570) who had received guided ICBT for panic disorder between 2007 and 2012 in a routine care setting at an out-patient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Panic Disorder Severity Scale-Self-report (PDSS-SR). RESULTS Participants made large improvements from screening and pretreatment assessments to posttreatment (Cohen's d range on the PDSS-SR = 1.07-1.55). Improvements were sustained at 6-month follow-up. CONCLUSION This study suggests that ICBT for panic disorder is as effective when delivered in a routine care context as in the previously published randomized controlled trials.
Collapse
Affiliation(s)
- E Hedman
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Røysland IØ, Dysvik E, Furnes B, Friberg F. Exploring the information needs of patients with unexplained chest pain. Patient Prefer Adherence 2013; 7:915-23. [PMID: 24043934 PMCID: PMC3772772 DOI: 10.2147/ppa.s47120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Unexplained chest pain is a common condition. Despite negative findings, a large number of these patients will continue to suffer from chest pain after being investigated at cardiac outpatient clinics. Unexplained chest pain covers many possible complaints, and diagnosing a single cause for a patient's pain is often described as difficult, as there are a number of possible factors that can contribute to the condition. For health professionals to meet patients' expectations, they must know more about the information needs of patients with unexplained chest pain. The aim of this study was to describe information needs among patients with unexplained chest pain and how those needs were met by health professionals during medical consultations. METHODS A qualitative design was used. Data were collected by means of seven individual interviews with four women and three men, aged 21-62 years. The interviews were analyzed by qualitative content analysis. RESULTS The results are described in two subthemes, ie, "experiencing lack of focus on individual problems" and "experiencing unanswered questions". These were further abstracted under the main theme "experiencing unmet information needs". CONCLUSION Existing models of consultations should be complemented to include a person-centered approach to meeting patients' beliefs, perceptions, and expressions of feelings related to experiencing unexplained chest pain. This is in line with a biopsychosocial model with active patient participation, shared decision-making, and a multidisciplinary approach. Such an approach is directly within the domain of nursing, and aims to take into account patient experience.
Collapse
Affiliation(s)
- Ingrid Ølfarnes Røysland
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Elin Dysvik
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Bodil Furnes
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Febe Friberg
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Institute of Health and Care Sciences, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
| |
Collapse
|
28
|
Schoenenberger AW, Felber S, Gujer S, Moser A, Jamshidi P, Stuck AE, Erne P. Invasive findings in patients with angina equivalent symptoms but no coronary artery disease; Results from the heart quest cohort study. Int J Cardiol 2013; 167:168-73. [DOI: 10.1016/j.ijcard.2011.12.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 12/08/2011] [Accepted: 12/17/2011] [Indexed: 12/31/2022]
|
29
|
Abstract
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.
Collapse
Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | | |
Collapse
|
30
|
Abstract
Panic attacks occur in about 2 % of the population. Symptoms include a racing or pounding heart beat, chest pain, dizziness, light-headedness, nausea, difficulty in breathing, tingling or numbness in the hands, flushes or chills, dreamlike sensations or perceptual distortions. The symptoms of paroxysmal supraventricular tachycardia (PSVT) may be similar. A PSVT is often difficult to document on the ECG since it has often ceased before the patient comes to medical attention. Besides, a tachycardia may still be present and even be documented but interpreted as a phenomenon secondary to the panic attack. In addition, ECG abnormalities between episodes can often not be identified. The evidence that in some patients paroxysmal SVT is the cause, but not the consequence of a panic attack, is based on observations that catheter ablation was able to cure patients presenting with panic disorders. To better establish the prevalence of SVT as the underlying mechanism of a panic attack, there is a need for prospective studies and/or registries. Whereas gastric ulcer has in some patients changed from a psychosomatic disorder to an infectious disease, we may hypothesise that a certain proportion of panic disorders may mutate into an underlying arrhythmia rather than a primary psychiatric disorder.
Collapse
|
31
|
Abstract
OBJECTIVE The aim of the present study was to investigate the association between panic disorder (PD) and atrial fibrillation (AF). METHODS We used a nationwide population-based data set from Taiwan. A total of 3888 patients with PD and without a diagnosis of AF from a sampled cohort data set of 1,000,000 were included in the study group. Ten people without PD and AF were selected for every 1 patient in the study group, matched by propensity score matching according to time of enrollment, age, sex, and comorbidities. We performed log-rank tests to analyze differences in accumulated AF-free survival rates between the two groups. Cox proportional hazard regressions were performed to evaluate the independent factors determining the longitudinal hazard of AF. RESULTS During a maximal 7-year follow-up, 48 patients from the study group (1.2% of the patients with PD) and 358 from the control group (0.9% of the patients without PD) were newly diagnosed as having AF. Patients with PD had a significantly higher incidence of AF (hazard ratio [HR] = 1.54 [1.14-2.09]; log-rank test, p = .004). After Cox model adjustment for risk factors and comorbidities, PD (HR = 1.73, 95% confidence interval [CI] = 1.26-2.37), age (HR = 1.07, 95% CI = 1.06-1.08), male sex (HR = 1.26, 95% CI = 1.03-1.55), hypertension (HR = 2.00, 95% CI = 1.55-2.56), history of coronary artery disease (HR = 1.45, 95% CI = 1.15-1.82), congestive heart failure (HR = 2.46; 95% CI, 1.84-3.30), and valvular heart disease (HR = 2.83, 95% CI = 1.85-4.42) were independently associated with increased risk of AF. CONCLUSIONS PD is independently associated with higher incidence of AF to be diagnosed in the future. Larger prospective studies or meta-analysis are suggested to confirm the findings.
Collapse
|
32
|
Zhang HL, Guo ZN, Yang G, Yang L, Han K, Wu J, Xing Y, Yang Y. Compromised cerebrovascular modulation in chronic anxiety: evidence from cerebral blood flow velocity measured by transcranial Doppler sonography. Neurosci Bull 2012; 28:723-8. [PMID: 23152329 DOI: 10.1007/s12264-012-1282-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/01/2012] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Cerebral autoregulation (CA) is the mechanism by which constant cerebral blood flow is maintained despite changes in cerebral perfusion pressure. CA can be evaluated by dynamic monitoring of cerebral blood flow velocity (CBFV) with transcranial Doppler sonography (TCD). The present study aimed to explore CA in chronic anxiety. METHODS Subjects with Hamilton anxiety scale scores ≥14 were enrolled and the dynamic changes of CBFV in response to an orthostatic challenge were investigated using TCD. RESULTS In both the anxious and the healthy subjects, the mean CBFV was significantly lower in the upright position than when supine. However, the CBFV changes from supine to upright differed between the anxious and the healthy groups. Anxious subjects showed more pronounced decreases in CBFV with abrupt standing. CONCLUSION Our results indicate that cerebrovascular modulation is compromised in chronic anxiety; anxious subjects have some insufficiency in maintaining cerebral perfusion after postural change. Given the fact that anxiety and impaired CA are associated with cardiovascular disease, early ascertainment of compromised cerebrovascular modulation using TCD might suggest interventional therapies in the anxious population, and improve the primary prevention of cardiovascular disease.
Collapse
Affiliation(s)
- Hong-Liang Zhang
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Changchun 130021, China
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Soares-Filho GLF, Mesquita CT, Mesquita ET, Arias-Carrión O, Machado S, González MM, Valença AM, Nardi AE. Panic attack triggering myocardial ischemia documented by myocardial perfusion imaging study. A case report. Int Arch Med 2012; 5:24. [PMID: 22999016 PMCID: PMC3502479 DOI: 10.1186/1755-7682-5-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/17/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Chest pain, a key element in the investigation of coronary artery disease is often regarded as a benign prognosis when present in panic attacks. However, panic disorder has been suggested as an independent risk factor for long-term prognosis of cardiovascular diseases and a trigger of acute myocardial infarction. OBJECTIVE Faced with the extreme importance in differentiate from ischemic to non-ischemic chest pain, we report a case of panic attack induced by inhalation of 35% carbon dioxide triggering myocardial ischemia, documented by myocardial perfusion imaging study. DISCUSSION Panic attack is undoubtedly a strong component of mental stress. Patients with coronary artery disease may present myocardial ischemia in mental stress response by two ways: an increase in coronary vasomotor tone or a sympathetic hyperactivity leading to a rise in myocardial oxygen consumption. Coronary artery spasm was presumed to be present in cases of cardiac ischemia linked to panic disorder. Possibly the carbon dioxide challenge test could trigger myocardial ischemia by the same mechanisms. CONCLUSION The use of mental stress has been suggested as an alternative method for myocardial ischemia investigation. Based on translational medicine objectives the use of CO2 challenge followed by Sestamibi SPECT could be a useful method to allow improved application of research-based knowledge to the medical field, specifically at the interface of PD and cardiovascular disease.
Collapse
Affiliation(s)
- Gastão Luiz Fonseca Soares-Filho
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, INCT - Translational Medicine (CNPq), Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Sardinha A, Araújo CGS, Nardi AE. Psychiatric disorders and cardiac anxiety in exercising and sedentary coronary artery disease patients: a case-control study. Braz J Med Biol Res 2012; 45:1320-6. [PMID: 23011407 PMCID: PMC3854216 DOI: 10.1590/s0100-879x2012007500156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/08/2012] [Indexed: 01/21/2023] Open
Abstract
Regular physical exercise has been shown to favorably influence mood and anxiety; however, there are few studies regarding psychiatric aspects of physically active patients with coronary artery disease (CAD). The objective of the present study was to compare the prevalence of psychiatric disorders and cardiac anxiety in sedentary and exercising CAD patients. A total sample of 119 CAD patients (74 men) were enrolled in a case-control study. The subjects were interviewed to identify psychiatric disorders and responded to the Cardiac Anxiety Questionnaire. In the exercise group (N = 60), there was a lower prevalence (45 vs 81%; P < 0.001) of at least one psychiatric diagnosis, as well as multiple comorbidities, when compared to the sedentary group (N = 59). Considering the Cardiac Anxiety Questionnaire, sedentary patients presented higher scores compared to exercisers (mean ± SEM = 55.8 ± 1.9 vs 37.3 ± 1.6; P < 0.001). In a regression model, to be attending a medically supervised exercise program presented a relevant potential for a 35% reduction in cardiac anxiety. CAD patients regularly attending an exercise program presented less current psychiatric diagnoses and multiple mental-related comorbidities and lower scores of cardiac anxiety. These salutary mental effects add to the already known health benefits of exercise for CAD patients.
Collapse
Affiliation(s)
- A Sardinha
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
| | | | | |
Collapse
|
35
|
Player MS, Peterson LE. Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med 2012; 41:365-77. [PMID: 22238841 DOI: 10.2190/pm.41.4.f] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension, coronary heart disease (CHD), and anxiety disorders all cause substantial morbidity to patients and costs to the healthcare system. Associations between these diseases have been hypothesized and studied for decades. In particular, psychosocial stressors associated with anxiety disorders raise autonomic arousal via the hypothalamic-pituitary axis which increases circulating catecholamines. This heightened arousal is associated with an increased risk of hypertension and a pro-inflammatory state and, consequently, development of coronary heart disease. This association holds across the spectrum of anxiety disorders (generalized anxiety, posttraumatic stress disorder, panic disorder, and obsessive compulsive disorder) and also when controlling for comorbid conditions such as depression and physical ailments. Multiple cross sectional studies reveal a positive association between anxiety and hypertension. These associations are bidirectional, with those with hypertension being more likely to have anxiety and those with anxiety being more likely to have hypertension. However, a few studies have shown no association. Longitudinal studies point to an increased risk of development of hypertension in patients who suffer from anxiety. More convincing studies show links between anxiety symptoms and disorders, including panic disorder and PTSD, and cardiovascular outcomes. Drawing broad conclusions from these studies is challenging, however, given the multiplicity of scales used to measure anxiety disorders. Anxiety, hypertension, and CHD are common conditions seen in primary care, and anxiety may be an important predictor of future CHD outcomes. Better recognition of the association of these conditions and the possible roles of each in development of the other should alert primary care providers to be vigilant in monitoring and treating anxiety, hypertension, and CHD.
Collapse
Affiliation(s)
- Marty S Player
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | |
Collapse
|
36
|
Diène E, Fouquet A, Esquirol Y. Cardiovascular diseases and psychosocial factors at work. Arch Cardiovasc Dis 2012; 105:33-9. [DOI: 10.1016/j.acvd.2011.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/02/2011] [Accepted: 10/04/2011] [Indexed: 01/19/2023]
|
37
|
Fischer D, Kindermann I, Karbach J, Herzberg PY, Ukena C, Barth C, Lenski M, Mahfoud F, Einsle F, Dannemann S, Böhm M, Köllner V. Heart-focused anxiety in the general population. Clin Res Cardiol 2011; 101:109-16. [PMID: 22015615 DOI: 10.1007/s00392-011-0371-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Heart-focused anxiety is a common phenomenon that is related to psychological disorders and cardiac diseases. We investigated heart-focused anxiety in the general population and provided standard values using the Cardiac Anxiety Questionnaire (CAQ). Furthermore, we assessed the reliability of the CAQ and investigated the influence of social variables on heart-focused anxiety. METHODS AND RESULTS The questionnaire was applied to 2,396 individuals (age range: 18-92; mean age 49 ± 17, 50% male). Three aspects of heart-focused anxiety (fear, attention, and avoidance) were captured by the CAQ. To test the influence of age, gender, and social factors, we performed analyses of variance, correlative statistics, and regression analyses. Heart-focused anxiety showed a linear increase with age (P < 0.001). No gender differences were observed. The degree of anxiety was affected by relationship (P < 0.001), level of education (P < 0.001), employment (P < 0.001), and income (P < 0.001). CONCLUSION We evaluated heart-focused anxiety in the general population and validated the CAQ. Using percentiles based on a normative sample allows screening for heart-focused anxiety in patients with or without cardiac diseases and the measurement of therapy success after psychotherapeutic or pharmacological intervention.
Collapse
Affiliation(s)
- Denise Fischer
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Kirrberger Straße, 66421, Homburg/Saar, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Sardinha A, Araújo CGS, Soares-Filho GLF, Nardi AE. Anxiety, panic disorder and coronary artery disease: issues concerning physical exercise and cognitive behavioral therapy. Expert Rev Cardiovasc Ther 2011; 9:165-75. [PMID: 21453213 DOI: 10.1586/erc.10.170] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychological factors such as stress and depression have already been established as primary and secondary cardiovascular risk factors. More recently, the role of anxiety in increasing cardiac risk has also been studied. The underlying mechanisms of increased cardiac risk in panic disorder patients seem to reflect the direct and indirect effects of autonomic dysfunction, as well as behavioral risk factors associated with an unhealthy lifestyle. Implications of the comorbidity between panic and cardiovascular disease include higher morbidity, functional deficits, increased cardiovascular risk, and poor adherence to cardiac rehabilitation or exercise programs. This article probes the most recent evidence on the association between coronary artery disease, anxiety and panic disorder, and discusses the potential role of incorporating regular physical exercise and cognitive behavioral therapy in the treatment of this condition.
Collapse
Affiliation(s)
- Aline Sardinha
- Laboratory of Panic and Respiration, Psychiatry Institute, Federal University of Rio de Janeiro (IPUB/UFRJ), National Institute for Translational Medicine (INCT-TM, CNPq), Rio de Janeiro, Brazil.
| | | | | | | |
Collapse
|
39
|
Wiltink J, Beutel ME, Till Y, Ojeda FM, Wild PS, Münzel T, Blankenberg S, Michal M. Prevalence of distress, comorbid conditions and well being in the general population. J Affect Disord 2011; 130:429-37. [PMID: 21106250 DOI: 10.1016/j.jad.2010.10.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purposes of this paper are to determine the prevalence of distress in the community, to identify its determinants and to assess its relationship to somatic conditions and subjective well being. METHODS Distress and associated factors were investigated in a random sample of 5000 participants (35-74 years) of a community-based, prospective, observational cohort study in western Mid-Germany ("Gutenberg Heart Study") between 04/2007 and 10/2008. The sample was stratified 1:1 for gender and residence and in equal strata for decades of age. Data were assessed by self-report instruments, interviews and medical examination. RESULTS We found a prevalence rate for depression of 7.2% (6.5-8.0%), social anxiety 7.0% (6.3-7.7%), panic 4.6% (4.0-5.2%), generalized anxiety 3.4% (2.9-3.9%), and Type D personality 22.1% (21.0-23.2%). Mental conditions declined by age. Depression was related to diabetes (OR=1.99, 95% CI=1.26-3.15), dyslipidemia (OR=1.35, 95% CI=1.02-1.79), coronary heart disease (CHD; OR=1.88, 95% CI=1.04-3.39), and the history of stroke (OR=2.43, 95% CI=1.02-5.76). Panic was related to the history of myocardial infarction (OR=2.46, 95% CI=1.15-5.25), and generalized anxiety to obesity (OR=1.65, 95% CI=1.11-2.44). Mental distress was unrelated to hypertension, atrial fibrillation and cancer. In ordinal logistic regression subjective physical and mental well being were associated with anxiety, depression and Type D personality. CONCLUSIONS While mental conditions are highly prevalent, especially depression is associated with several somatic conditions. Mental and physical well being are strongly related to mental conditions. Future work should take into account comorbid conditions when identifying the impact of depression on CHD.
Collapse
Affiliation(s)
- Jörg Wiltink
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
McBride D, Hardoon S, Walters K, Gilmour S, Raine R. Explaining variation in referral from primary to secondary care: cohort study. BMJ 2010; 341:c6267. [PMID: 21118873 PMCID: PMC2995017 DOI: 10.1136/bmj.c6267] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the extent to which referral for defined symptoms from primary care varies by age, sex, and social deprivation and whether any sociodemographic variations in referral differ according to the presence of national referral guidance and the potential of the symptoms to be life threatening. DESIGN Cohort study using individual patient data from the health improvement network database in primary care. SETTING United Kingdom. PARTICIPANTS 5492 patients with postmenopausal bleeding, 23 121 with hip pain, and 101 212 with dyspepsia from 326 general practices, 2001-7. MAIN OUTCOME MEASURES Multivariable associations between odds of immediate referral for postmenopausal bleeding and age and social deprivation; hazard rates of referral for hip pain or dyspepsia and age, sex, and social deprivation. Analyses for dyspepsia were stratified for people aged less than and more than 55 years because referral guidance differs by age. RESULTS 61.4% (3374/5492) of patients with postmenopausal bleeding, 17.4% (4019/23 121) with hip pain, and 13.8% (13 944/101 212) with dyspepsia were referred. The likelihood of referral for postmenopausal bleeding declined with increasing age: the adjusted odds ratio for patients aged 85 or more compared with those aged 55-64 was 0.39 (95% confidence interval 0.31 to 0.49). Patients aged 85 or more with hip pain were also less likely to be referred than those aged 55-64 (0.68, 0.57 to 0.81). Women were less likely than men to be referred for hip pain (hazard ratio 0.90, 95% confidence interval 0.84 to 0.96). More deprived patients with hip pain or dyspepsia (if aged <55) were less likely to be referred. Adjusted hazard ratios for those in the most deprived Townsend fifth compared with the least deprived were 0.72 (95% confidence interval 0.62 to 0.82) and 0.76 (0.68 to 0.85), respectively. No socioeconomic gradient was evident in referral for postmenopausal bleeding. CONCLUSIONS Inequalities in referral associated with socioeconomic circumstances were more likely to occur in the absence of both explicit guidance and potentially life threatening conditions, whereas inequalities with age were evident for all conditions.
Collapse
Affiliation(s)
- Dulcie McBride
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
| | | | | | | | | |
Collapse
|
41
|
Marston L, Carpenter JR, Walters KR, Morris RW, Nazareth I, Petersen I. Issues in multiple imputation of missing data for large general practice clinical databases. Pharmacoepidemiol Drug Saf 2010; 19:618-26. [PMID: 20306452 DOI: 10.1002/pds.1934] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Missing data are a substantial problem in clinical databases. This paper aims to examine patterns of missing data in a primary care database, compare this to nationally representative datasets and explore the use of multiple imputation (MI) for these data. METHODS The patterns and extent of missing health indicators in a UK primary care database (THIN) were quantified using 488 384 patients aged 16 or over in their first year after registration with a GP from 354 General Practices. MI models were developed and the resulting data compared to that from nationally representative datasets (14 142 participants aged 16 or over from the Health Survey for England 2006 (HSE) and 4 252 men from the British Regional Heart Study (BRHS)). RESULTS Between 22% (smoking) and 38% (height) of health indicator data were missing in newly registered patients, 2004-2006. Distributions of height, weight and blood pressure were comparable to HSE and BRHS, but alcohol and smoking were not. After MI the percentage of smokers and non-drinkers was higher in THIN than the comparison datasets, while the percentage of ex-smokers and heavy drinkers was lower. Height, weight and blood pressure remained similar to the comparison datasets. CONCLUSIONS Given available data, the results are consistent with smoking and alcohol data missing not at random whereas height, weight and blood pressure missing at random. Further research is required on suitable imputation methods for smoking and alcohol in such databases.
Collapse
Affiliation(s)
- Louise Marston
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London NW32PF, UK.
| | | | | | | | | | | |
Collapse
|
42
|
Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol 2010; 56:38-46. [PMID: 20620715 DOI: 10.1016/j.jacc.2010.03.034] [Citation(s) in RCA: 562] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/28/2010] [Accepted: 03/03/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the association between anxiety and risk of coronary heart disease (CHD). BACKGROUND Less research has focused on the association of anxiety with incident CHD in contrast to other negative emotions, such as depression. METHODS A meta-analysis of references derived from PubMed, EMBASE, and PsycINFO (1980 to May 2009) was performed without language restrictions. End points were cardiac death, myocardial infarction (MI), and cardiac events. The authors selected prospective studies of (nonpsychiatric) cohorts of initially healthy persons in which anxiety was assessed at baseline. RESULTS Twenty studies reporting on incident CHD comprised 249,846 persons with a mean follow-up period of 11.2 years. Anxious persons were at risk of CHD (hazard ratio [HR] random: 1.26; 95% confidence interval [CI]: 1.15 to 1.38; p < 0.0001) and cardiac death (HR: 1.48; 95% CI: 1.14 to 1.92; p = 0.003), independent of demographic variables, biological risk factors, and health behaviors. There was a nonsignificant trend for an association between anxiety and nonfatal MI (HR: 1.43; 95% CI: 0.85 to 2.40; p = 0.180). Subgroup analyses did not show any significant differences regarding study characteristics, with significant associations for different types of anxiety, short- and long-term follow-up, and both men and women. CONCLUSIONS Anxiety seemed to be an independent risk factor for incident CHD and cardiac mortality. Future research should examine the association between anxiety and CHD with valid and reliable anxiety measures and focus on the mechanisms through which anxiety might affect CHD.
Collapse
Affiliation(s)
- Annelieke M Roest
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | | | | | | |
Collapse
|
43
|
Budzyński J, Pulkowski G, Kłopocka M, Augustyńska B, Sinkiewicz A, Suppan K, Fabisiak J, Majer M, Świątkowski M. Treatment with double dose of omeprazole increases β-endorphin plasma level in patients with coronary artery disease. Arch Med Sci 2010; 6:201-7. [PMID: 22371748 PMCID: PMC3281341 DOI: 10.5114/aoms.2010.13896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 01/17/2009] [Accepted: 01/22/2009] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The proton pump inhibitor empirical trial, besides the analysis of symptoms, is the main method in the diagnosis of gastro-oesophageal reflux disease-related chest pain. β-Endorphin acts as an endogenous analgesia system. The aim of the study was verify whether β-endorphin plasma level is affected by omeprazole administration and influences the severity of anginal symptoms and outcome of the "omeprazole test" in patients with coronary artery disease (CAD) and chest pain of suspected non-cardiac origin. MATERIAL AND METHODS Omeprazole was administered to 48 patients with CAD in a randomized, placebo-controlled, crossover study design. At the beginning of the study, and again after the 14-day omeprazole and placebo treatment, the β-endorphin plasma concentration was determined. RESULTS The level of plasma β-endorphin after the administration of omeprazole was significantly greater than at the start of the study and following the placebo. Responders to omeprazole had an average lower β-endorphin plasma concentration than subjects who failed to respond to this therapy. Subjects with symptoms in class III (according to the Canadian Cardiovascular Society classification) after omeprazole administration had a greater β-endorphin plasma level than subjects in class II for anginal symptom severity. CONCLUSIONS Fourteen-day therapy with a double omeprazole dose significantly increases the β-endorphin plasma concentration in patients with CAD. Circulating β-endorphin does not seem to be involved in the mechanism for the "omeprazole test" outcome, although an individually different effect on pain threshold cannot be excluded.
Collapse
Affiliation(s)
- Jacek Budzyński
- Department of Gastroenterology, Vascular Diseases and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Grzegorz Pulkowski
- Clinical Ward of Vascular Diseases and Internal Medicine, Doctor Jan Biziel University Hospital no. 2, Bydgoszcz, Poland
| | - Maria Kłopocka
- Department of Gastroenterology, Vascular Diseases and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Beata Augustyńska
- Department of Psychiatric Nursing, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Anna Sinkiewicz
- The Outpatient Phoniatrics Department, Doctor Jan Biziel University Hospital no. 2 in Bydgoszcz, Poland
| | - Karol Suppan
- Department of Gastroenterology, Vascular Diseases and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Jacek Fabisiak
- Department of Gastroenterology, Vascular Diseases and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Marcin Majer
- Clinical Ward of Vascular Diseases and Internal Medicine, Doctor Jan Biziel University Hospital no. 2, Bydgoszcz, Poland
| | - Maciej Świątkowski
- Department of Gastroenterology, Vascular Diseases and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| |
Collapse
|
44
|
Rutledge T, Linke SE, Krantz DS, Johnson BD, Bittner V, Eastwood JA, Eteiba W, Pepine CJ, Vaccarino V, Francis J, Vido DA, Merz CNB. Comorbid depression and anxiety symptoms as predictors of cardiovascular events: results from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. Psychosom Med 2009; 71:958-64. [PMID: 19834049 PMCID: PMC2783707 DOI: 10.1097/psy.0b013e3181bd6062] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To study the independent and interactive effects of depression and anxiety symptoms as predictors of cardiovascular disease (CVD) events in a sample of women with suspected myocardial ischemia. Symptoms of depression and anxiety overlap strongly and are independent predictors of CVD events. Although these symptoms commonly co-occur in medical patients, little is known about combined effects of depression and anxiety on CVD risk. METHOD A total of 489 women completed a baseline protocol including coronary angiogram, CVD risk factor assessment, and questionnaire-based measures of depression and anxiety symptoms, using the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI), respectively. Participants were followed for a median 5.9 years to track the prevalence of CVD events (stroke, myocardial infarction, heart failure, and CVD-related mortality). We tested the BDI x STAI interaction effect in addition to the BDI and STAI main effects. RESULTS Seventy-five women (15.3% of sample) experienced a CVD event, of which 18 were deaths attributed to cardiovascular causes. Results using Cox regression indicated a significant BDI x STAI interaction effect in the prediction of CVD events (p = .02) after covariate adjustment. Simple effect analyses indicated that depression scores were significant predictors of CVD events among women with low anxiety scores (hazard ratio [HR] = 2.3 [in standard deviation units]; 95% Confidence Interval [CI] = 1.3-3.9; p = .005) but not among women with higher levels of anxiety (HR = 0.99; 95% CI = 0.70-1.4; p = .95). CONCLUSION Among women with suspected myocardial ischemia, the value of depression symptoms for predicting CVD events varied by the severity of comorbid anxiety. These results suggest that the clinical utility of depression measures may be improved by using them in combination with measures of anxiety.
Collapse
Affiliation(s)
- Thomas Rutledge
- VA San Diego Healthcare Syste, University of California, San Diego, San Diego, California, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Giugliano RP, Braunwald E. The Year in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2009; 54:1544-55. [DOI: 10.1016/j.jacc.2009.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 06/28/2009] [Indexed: 12/19/2022]
|
46
|
Hoge EA, Brandstetter K, Moshier S, Pollack MH, Wong KK, Simon NM. Broad spectrum of cytokine abnormalities in panic disorder and posttraumatic stress disorder. Depress Anxiety 2009; 26:447-55. [PMID: 19319993 DOI: 10.1002/da.20564] [Citation(s) in RCA: 251] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Proinflammatory cytokines have been reported to be elevated in individuals experiencing chronic stress as well as in those with major depressive disorder. Much less is known about cytokines in anxiety disorders such as posttraumatic stress disorder (PTSD) and panic disorder (PD). We hypothesized that PD and PTSD would be associated with a generalized proinflammatory cytokine signature. METHOD We utilized Luminex technology to examine 20 cytokines and chemokines in serum from 48 well-characterized individuals with a primary DSM-IV PD or PTSD diagnosis, and 48 age- and gender-matched healthy controls. We conservatively employed a Bonferroni correction for multiple testing (alpha=.05/20=.0025). RESULTS Individuals with primary PTSD or PD had significantly elevated median peripheral cytokine levels for 18 of 20 different cytokines compared to age- and gender-matched healthy controls (all P<.0025). To assess for the presence of a generalized proinflammatory state, we also examined the proportion of subjects with detectable levels of at least six of nine common proinflammatory cytokines and chemokines (IL-6, IL-1alpha, IL-1beta, IL-8, MCP-1, MIP-1alpha, Eotaxin, GM-CSF, and IFN-alpha). For men and women, 87% of anxiety patients had six or more detectable levels of these proinflammatory cytokines, compared with only 25% of controls (Fisher's Exact Test (FET) P=.000). Confirmatory analysis of the subset of individuals without current psychiatric medication use or comorbid depression was of comparable significance. CONCLUSIONS These findings suggest that a generalized inflammatory state may be present in individuals with PD or PTSD.
Collapse
Affiliation(s)
- E A Hoge
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | | | | | | | | | | |
Collapse
|
47
|
Clinical News. Br J Hosp Med (Lond) 2009. [DOI: 10.12968/hmed.2009.70.2.38903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
People who have been diagnosed with panic attacks or panic disorder have a greater risk of subsequently developing heart disease or suffering a heart attack than the normal population, with higher rates occurring in younger people (Walters et al, 2008).
Collapse
|