Abstract
Depression is an established risk factor for acute coronary syndrome (ACS), with an impact on cardiac prognosis; nonetheless, the literature disagrees on the role played by anxiety. No study has evaluated this relationship in a cardiac population with no history of depression and after their first diagnosis of ACS. The aim of this study is to explore these associations without the confounding role of long-lasting heart disease or psychiatric illnesses. Two hundred sixty-six patients with no history of depression completed the Hospital Anxiety and Depression Scale and the Primary Care Evaluation of Mental Disorder at baseline and at 1, 2, 4, 6, 9, 12, and 24 months follow-up after their first diagnosis of ACS. During the follow-up period, we collected information regarding the major adverse cardiac events. Developing a first-ever depressive episode, in a proportional hazard model, was associated with almost 3 times the risk of a recurrent cardiac event (odds ratio = 2.590, 95% confidence interval [CI] [1.321, 5.078], p = .006). Furthermore, a moderation analysis revealed that increasing levels of baseline anxiety had opposing effects on cardiac outcomes, being protective only in those who did not develop incident depression (B = -0.0824, 95% CI [-0.164, -0.005], p = .048). No dose-response effect between depressive or anxious symptoms and cardiac outcomes emerged. Our results confirm the detrimental effect of depression on cardiac prognosis in a selected population and suggest that anxiety after the first diagnosis of ACS might have different roles depending on the illness' course. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Highlights
The detrimental effect of mental illnesses (Correll et al, 2017), and depression on cardiac outcome is well-established (Burg et al, 2013; Carney et al, 2003; Geulayov, Novikov, Dankner, & Dankner, 2018; Meijer et al, 2013; Nicholson, Kuper, & Hemingway, 2006)
Biomarkers further distinguished non–ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (Hamm et al, 2011); (b) they had no history of major depression; (c) they did not satisfy the criteria for major depression at baseline; (c) they were over 18 years old; (d) they were proficient in Italian language; (e) they had no substance abuse or other dependencies; (f) they showed no cognitive impairment as demonstrated by a Mini Mental State Examination (MMSE) (Folstein, Folstein, & McHugh, 1975) lower than 25; (f) they did not take any psychotropic medication
This study evaluated in a sample of never depressed patients, at their first Acute Coronary Syndrome, the risk factors for the development of recurrent major adverse cardiovascular event (MACE) within the two successive years
Summary
The detrimental effect of mental illnesses (Correll et al, 2017), and depression on cardiac outcome is well-established (Burg et al, 2013; Carney et al, 2003; Geulayov, Novikov, Dankner, & Dankner, 2018; Meijer et al, 2013; Nicholson, Kuper, & Hemingway, 2006) It remains unclear (Carney & Freedland, 2012) as to what extent first-time incident depression, here defined as the first episode of depression, occurring after the onset of coronary disease in never depressed people, is cardio-toxic (Goodman, Shimbo, Haas, Davidson, & Rieckmann, 2008; Meyer, Hussein, Lange, & Herrmann-Lingen, 2014; Osler et al, 2016; Surtess et al, 2008) or if a dose-response relationship between the depressive symptoms and cardiac outcome exists (Smolderen, Buchanan, et al, 2017). Some authors suggest that it increases the risk of adverse cardiac outcomes (de Jager et al, 2018; Van Beek et al, 2016), others finding that it exerts a protective effect on new cardiac events (Meyer, Hussein, Lange, & HerrmannLingen, 2015) and yet another study, (Geulayov et al, 2018) not finding any effect on mortality
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