Anxiety and depression and secondary prevention of coronary heart disease in 14 countries across six WHO regions: the INTERASPIRE study

Aims Anxiety and depression are associated with poor outcomes in patients with coronary heart disease (CHD), however their association with achieving recommended cardiovascular prevention standards is unclear. We examined this association across all World Health Organization (WHO) regions. Methods and results Cross-sectional analysis of the INTERASPIRE study of adults hospitalized in the preceding 6–24 months with incident or recurrent CHD who underwent a standardized interview and examination (2020–2023) across 14 countries. The main outcome was the INTERASPIRE-Guideline Target Score (GTS); a 10-point assessment of achieving secondary prevention lifestyle, risk factor, and therapeutic targets. A total of 4546 patients (21.1% women) with a mean (SD) age of 60.0 (10.3) were interviewed. Prevalence’s of anxiety and/or depression were greater in women than men, and prevalence of CHD lifestyle and behavioral risk factors increased alongside severity of anxiety and depression symptoms. Compared to those without symptoms, adjusted odds ratios for achieving a suboptimal INTERASPIRE-GTS were: 1.52 (95% CI 1.13–2.04, P = 0.006) for symptoms of depression; 1.57 (95% CI 1.09–2.26, P = 0.015) for “possible” comorbid anxiety and depression; and 2.09 (95% CI 1.22–3.57, P = 0.007) for those with “probable” comorbid anxiety and depression. Conclusion Increasing severity of depression and anxiety symptoms are associated with reduced potential for achieving guideline standards for CHD secondary prevention. Secondary prevention programs should integrate risk-stratified management of individuals with symptoms of anxiety and/or depression to improve CHD guideline targets. Lay summary We examined if patients with symptoms of anxiety and/or depression were more or less likely to achieve guideline standards for secondary prevention of coronary heart disease (CHD).Increasing severity of symptoms of anxiety and depression was associated with reduced potential for achieving guideline standards for secondary prevention of CHD.A higher proportion of women with CHD experience more severe levels of anxiety and depression on their own, and combined as a comorbidity.Patients with CHD should be treated holistically, acknowledging the heart and mind connection.