Scared to Death? Anxiety and cardiovascular events in patients with CAD

January 01, 0001

Scared to Death? Anxiety and cardiovascular events in patients with CAD

These Dutch and US investigators evaluated the effect of generalized anxiety disorder (GAD) on subsequent cardiovascular events in a prospective cohort study. They also assessed the extent to which this association is explained by cardiac disease severity and potential behavioral or biological mediators. Participants (n=1015) were recruited between September 2000, and December 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up until March 2009, a mean of 5.6 years.

They found: "A total of 371 cardiovascular events occurred during 5711 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 9.6% in the 106 participants with GAD and 6.6% in the 909 participants without GAD (significant). After adjustment for demographic characteristics, comorbid conditions (including major depressive disorder), cardiac disease severity, and medication use, GAD remained associated with a 62% higher rate of cardiovascular events (hazard ratio, 1.62). Additional adjustment for a variety of potential behavioral and biological mediators had little effect on this association (hazard ratio, 1.74)."

The authors concluded: "In outpatients with CHD, a robust association between GAD and cardiovascular events was found that could not be explained by disease severity, health behaviors, or biological mediators. How GAD leads to poor cardiovascular outcomes deserves further study."

It would have been helpful to determine whether there was increased all-cause mortality in the group with GAD. Maybe they really are scared to death and maybe not.

For the full abstract, click here.

Arch Gen Psychiatry 67(7):750-758, July 2010
© 2010 to the American Medical Association
Scared to Death? Generalized Anxiety Disorder and Cardiovascular Events in Patients With Stable Coronary Heart Disease-The Heart and Soul Study. Elisabeth J. Martens, Peter de Jonge, Beeya Na, Beth E. Cohen, Heather Lett, Mary A. Whooley. Correspondence to Dr. Martens: [email protected]

Category: P. Psychological, K. Circulatory. Keywords: generalized anxiety disorder, coronary artery disease, cardiovascular events, prospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 3rd August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.