A Systematic Review of Psychological Distress as a Risk Factor for Recurrent Cardiac Events in Patients with Coronary Artery Disease

PURPOSE: The purpose of this study was to determine whether psychological distress is an independent risk factor for recurrent cardiac events in patients with coronary artery disease (CAD). METHODS: A prospective cohort of studies that measured psychological distress and the incidence of recurrent cardiac events in the adult population were included. Three computerized databases were assessed (PubMed, CINAHL, and PSYCINFO). Meta-analysis was conducted using a random-effects model to determine summary estimates of risks of major recurrent cardiac events associated with each psychological distress. Of 506 publications identified, 33 met inclusion criteria, and 24 studies were used to estimate effect size of psychological distress on recurrent cardiac events. RESULTS: Mean number in the research sample was 736 and mean time of follow-up was 4.0 years. Depression, anxiety, anger, and hostility as psychological factors were studied. According to estimation of effect size using random model effect, depression (OR=1.39, 95% CI: 1.22-1.57), anxiety (OR=1.22, 95% CI: 0.96-1.56), and anger/hostility (OR=1.29, 95% CI: 1.07-1.57) CAD patients in significantly increased risk for recurrent cardiac events. CONCLUSION: Finding suggests that psychological distress in forms of depression, anxiety, anger, and hostility impact unfavorably on recurrent cardiac events in CAD patients.