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July 28, 2014European Journal of Preventive CardiologyOpen Access

Prognostic value of one-year course of symptoms of anxiety and depression in patients with coronary heart disease: Role of physical activity and unmet medical need

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Why the study?

Does the one-year course of symptoms of anxiety and depression predict fatal and non-fatal cardiovascular disease events in patients with stable coronary heart disease?

Population

996 patients aged 30-70 years with stable coronary heart disease.

Comparison

One-year course of symptoms of anxiety and… vs Patients with a normal symptom score at baseline…

Design

Cohort

Follow-up

median 8.9 years

Authors

DRDietrich RothenbacherUniversität UlmAJAndrea JaenschHelmholtz-Institute UlmUMUte MonsGerman Cancer Research Center

Discussion

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Implication

Depressive symptom increases may flag higher CVD risk in stable CHD; leaves open physical activity mediation and need for prospective trials.

Key Points

  • To evaluate how the one-year trajectory of anxiety and depressive symptoms relates to 10-year fatal and non-fatal cardiovascular events in patients with stable coronary heart disease.
  • Prospective cohort study of N=996 patients aged 30–70 years with stable coronary heart disease.
  • Assessed anxiety and depression symptoms at baseline and one-year follow-up using the Hospital Anxiety and Depression Scale.
  • Tracked fatal and non-fatal cardiovascular disease events over a median follow-up of 8.9 years using Cox proportional hazards models.
  • Among 862 patients with normal baseline depression scores, 10.3% showed increased scores at one year, while 62.7% of those with elevated baseline scores remained elevated.
  • An increase in depressive symptoms over one year was associated with higher cardiovascular risk (HR 1.93, 95% CI 1.08–3.34; p-trend = 0.029) across 152 observed events.
  • Adjustment for physical activity attenuated the risk to non-significance, and overall antidepressant medication utilization was low at 2%.

Structured PICO

Does the one-year course of symptoms of anxiety and depression predict fatal and non-fatal cardiovascular disease events in patients with stable coronary heart disease?

P
Population
996 patients aged 30-70 years with stable coronary heart disease.
I
Intervention
One-year course of symptoms of anxiety and depression (evaluated using the Hospital Anxiety and Depression Scale)
C
Comparator
Patients with a normal symptom score at baseline and at one-year follow-up
O
Outcome
Fatal and non-fatal cardiovascular disease events during 10-year follow-upcomposite

An increase in depressive symptoms over one year is associated with a higher risk of long-term cardiovascular events in patients with stable coronary heart disease, an effect that may be partly mediated by a lack of physical activity.

Cite This Study

Rothenbacher et al. (2014) studied this question.

synapsesocial.com/papers/6a7104caf44fa9f079dec7afhttps://doi.org/10.1177/2047487314545317
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Are poor health behaviours in anxious and depressed cardiac patients explained by sociodemographic factors?2012 · 46 citations
  2. 2Should Global Burden of Disease Estimates Include Depression as a Risk Factor for Coronary Heart Disease?2011 · 82 citations
  3. 3Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies2006 · 1,362 citations
  4. 4Executive Summary: Heart Disease and Stroke Statistics—2012 Update2012 · 1,519 citations
  5. 5Symptoms of anxiety and depression in patients with stable coronary heart disease: prognostic value and consideration of pathogenetic links2007 · 104 citations