Abstract
Aim:To identify associations of anxiety symptoms (AS) and depressive symptoms (DS) with other psychosocial and lifestyle risk factors in primary care patients with arterial hypertension (AH) and/or coronary heart disease (CHD).Methods:COMETA (Clinical-epidemiOlogical prograM of studying psychosocial risk factors in cardiological practice in patiEnts with arterial hyperTension and ischemic heArt disease) is a multicenter cross-sectional study performed in 30 big cities of Russia with two to five out-patient clinics per city randomly selected and two to five general practitioners (GPs) per an out-patient clinic. Each GP included 8–10 consecutive patients with AH and/or CHD. AS and DS were assessed by the Hospital Anxiety and Depression Scale.Results:325 GPs enrolled 2775 patients (mean age 66.7 years, 72% women) with AH (60.8%), CHD (2.6%), and AH plus CHD (36.6%). Moderate/severe (≥11 HADS) AS were found in 25.5% and DS in 16.3% patients. The strongest associations of AS and DS were revealed for high stress level (OR 5.79; 95% CI [4.18–8.03]), moderate stress level (OR 2.34; 95% CI [1.73–3.16]), low social support (OR 1.87; 95% CI [1.31–2.68]) and female gender (OR 1.78; 95% CI [1.41–2.25]). Low physical activity, unhealthy eating, unemployment and low income were also positively associated with both AS and DS (p < 0.003 for all).Conclusion:In out-patients with AH and CHD, AS and DS were strongly associated with higher levels of stress, low social support, unemployment, low family income and unhealthy lifestyle such as low physical activity, low fruit and vegetables intake and excessive salt consumption. Our findings indicate that patients with AH and CHD, who have anxiety and depressive symptoms need extra attention and monitoring in regard to stress and lifestyle risk factor control.
Highlights
Both anxiety and depressive disorders as well as their subclinical symptoms are known as psychosocial risk factors for cardiovascular disease (CVD) in healthy people [1, 2], and are recognized as risk factors for cardiovascular events and mortality in patients with known CVD [3, 4]
More than two–thirds (66.5%) of patients were free from both anxiety and depressive moderate to severe symptoms, and 8.3% participants had coexisting moderate to severe anxiety and depressive symptoms
Pogosova et al: Factors Associated with Anxiety and Depressive Symptoms in 2775 Patients with Arterial Hypertension and Coronary Heart Disease
Summary
Both anxiety and depressive disorders as well as their subclinical symptoms are known as psychosocial risk factors for cardiovascular disease (CVD) in healthy people [1, 2], and are recognized as risk factors for cardiovascular events and mortality in patients with known CVD [3, 4]. The EUROASPIRE III, IV and V surveys [13,14,15] included assessment of anxiety and depressive symptoms and their associations with other cardiovascular risk factors in patients with coronary heart disease (CHD). The obvious strength of the EUROASPIRE surveys is the possibility to obtain a unique Europe-wide snapshot of multiple risk factors and clinical characteristics in CHD patients from a large number of European countries. These surveys were performed in limited number of participating centers (most academic or tertiary clinics) and limited number of patients in each country. This highlights the need for more widespread and country specific research, anxiety and depressive symptoms may be influenced by cultural differences or by socioeconomic factors [16,17,18,19]
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