Anxiety In Coronary Heart Disease Patients Research Articles

Longer term benefits of exercise and escitalopram in the treatment of anxiety in patients with coronary heart disease: Six month follow-up of the UNWIND randomized clinical trial

Anxiety is a common comorbidity in patients with coronary heart disease (CHD) and is associated with worse prognosis. However, effective treatment for anxiety in CHD patients is uncertain. The UNWIND randomized clinical trial showed that 12-week treatment of escitalopram was better than exercise training or placebo in reducing anxiety in anxious CHD patients. The longer-term benefits of treatment for anxiety are not known. Patients were randomized to 12 weeks of Escitalopram (up to 20 mg), Exercise (3 times/wk), or placebo pill. At the conclusion of treatment, participants were followed for 6-months to determine the persistence of benefit on the primary anxiety endpoint assessed by the Hospital Anxiety and Depression Scale-Anxiety scale (HADS-A) and to assess the effects of treatment on major adverse cardiac events over a follow-up period of up to 6 years. Of the 128 participants initially randomized, 120 (94%) were available for follow-up. Participants randomized to the Escitalopram condition exhibited lower HADS-A scores (3.9 [3.1, 4.7]) compared to those randomized to Exercise (5.5 [4.6, 6.3]) (P = .007) and Placebo (5.3 [4.1, 6.5]) (P = .053). Over a median follow-up of 3.2 years (IQR: 2.3, 4.5), there were 29 adverse events but no significant between-group differences. In the UNWIND trial, 12 weeks of escitalopram treatment was effective in reducing anxiety. These beneficial effects were sustained for 6 months posttreatment. Although moderate or vigorous physical activity has a number of health benefits, exercise was not an effective treatment for anxiety in patients with CHD.

A feasibility study of the Attention Training Technique in a group format for anxiety and depression in outpatients with coronary heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Significant symptoms of anxiety and depression are prevalent (30-40%) in coronary heart disease (CHD) patients and these are associated with a greater risk of death, recurrent cardiovascular events, poorer quality of life, and more frequent use of healthcare services compared to those without this heart condition. To date, only a few psychological treatments have shown limited effectiveness on symptoms of anxiety and depression in CHD patients. Therefore, it is essential to develop and evaluate more effective treatments for depression and anxiety in CHD patients. Metacognitive therapy (MCT) is effective in reducing significant symptoms of anxiety and depression. A key component of MCT is the attention training technique (ATT), which is based on the self-regulatory executive function model. According to the MCT treatment manual, ATT is brief and does not require extensive training to be delivered by health care personnel in routine care. A review of the empirical evidence shows that ATT can be as effective as full MCT in alleviating anxiety and depressive symptoms. However, ATT has not yet been used as a stand-alone intervention in treating symptoms of anxiety and depression in CHD patients. Purpose To evaluate the feasibility of implementing group ATT in CHD patients with significant symptoms of anxiety and depression and describe changes in these symptoms. Methods Five consecutively referred CHD patients with significant anxiety and depressive symptoms, as assessed by the Hospital Anxiety and Depression Scale (HADS)-Anxiety or Depression subscale score > 8, were included in the study. They received six weekly group sessions of ATT in an open trial. Outcomes included symptoms measured by HADS at baseline, post-treatment and at six months follow-up. We also assessed psychiatric diagnoses and specific psychological factors (type D personality, insomnia, worry and rumination) as secondary measures. Results The sample comprised of five men between 52 and 65 years of age, with a mean age of 59.9 years. Four of the patients attended all six sessions, and one patient attended all but one session. The mean HADS-A scores at baseline, post-treatment, and follow up were 9.4 (SD 3.0), 4.2 (SD 3.0) and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (3.7) and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Wilcoxon Signed Rank Tests revealed a significant change in outcome from pre- to post-treatment for HADS-A and worry, which was maintained at 6-months follow-up, and HADS-D significantly decreased from pre-treatment to 6-months follow up. Conclusions ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients with significant symptoms of anxiety or depression. Based on these preliminary results, we believe that an adequately powered randomised controlled trial is now warranted.

Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: A meta-analysis.

BACKGROUNDRecently, the efficacy of cognitive behavioral therapy (CBT)-based intervention on health outcomes in patients with coronary heart disease (CHD) has been recognized in randomized controlled trials (RCTs), but no comprehensive systematic review has been conducted. To address this research gap, our study aimed to evaluate whether comprehensive CBT-based interventions positively affect health outcomes in CHD patients. It was hypothesized that CBT-based interventions are effective in: (1) Reducing depression, anxiety, and stress symptoms; (2) Reducing body mass index, blood pressure, and lipid levels; and (3) Improving quality of life, and exercise endurance.AIMTo verify the effectiveness of CBT-based interventions on CHD patients through a meta-analysis of previous publications.METHODSRelevant RCTs published in English were obtained by searching electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Proquest, with the retrieval time from inception to August 2020. The primary outcomes were psychological factors (depression, anxiety, and stress symptoms), physiological factors (body mass index, blood pressure, blood lipids). The secondary outcomes included quality of life and exercise endurance. We used Review Manager 5.3 to conduct the meta-analysis and used the Physiotherapy Evidence Database tool to evaluate the quality of studies.RESULTSA total of 22 RCTs comprising 4991 patients with CHD were included in the systematic review and meta-analysis. The main analysis revealed that CBT-based intervention can reduce depression symptoms: -2.00 [95% confidence interval (CI): -2.83 to -1.16, P < 0.001]; anxiety symptoms: -2.07 (95%CI: -3.39 to -0.75, P = 0.002); stress symptoms: -3.33 (95%CI: -4.23 to -2.44, P < 0.001); body mass index: -0.47 (95%CI: -0.81 to -0.13, P = 0.006); and improve physical functioning: 3.36 (95%CI: 1.63 to 5.10, P = 0.000) and mental functioning: 6.91 (95%CI: 4.10 to 9.73, P < 0.001). Moreover, subgroup analysis results showed that CBT-based interventions were more effective for symptoms of depression and anxiety in CHD patients when individual, as opposed to group treatment, and psycho-education, behavioral and cognitive strategies were applied as the core treatment approaches.CONCLUSIONCBT-based interventions are effective treatment strategies for CHD patients, significantly improving their symptoms of depression, anxiety and stress, body mass index, and health-related quality of life.

Anxiety disturbs the blood plasma metabolome in acute coronary syndrome patients

Coronary heart disease (CHD) is the result of a complex metabolic disorder caused by various environmental and genetic factors, and often has anxiety as a comorbidity. Rupture of atherosclerotic plaque in CHD patients can lead to acute coronary syndrome (ACS). Anxiety is a known independent risk factor for the adverse cardiovascular events and mortality in ACS, but it remains unclear how stress-induced anxiety behavior impacts their blood plasma metabolome and contributes to worsening of CHD. The present study aimed to determine the effect of anxiety on the plasma metabolome in ACS patients. After receiving ethical approval 26 ACS patients comorbid anxiety were recruited and matched 26 ACS patients. Blood plasma samples were collected from the patients and stored at − 80 °C until metabolome profiling. Metabolome analysis was performed by liquid chromatography mass spectrometry (LC–MS), and the data were subjected to multivariate analysis. Disturbance of 39 plasma metabolites was noted in the ACS with comorbid anxiety group compared to the ACS group. These disturbed metabolites were mainly involved in tryptophan metabolism, pyrimidine metabolism, glycerophospholipid metabolism, pentose phosphate pathway, and pentose and glucuronate interconversions. The most significantly affected pathway was tryptophan metabolism including the down-regulation of tryptophan and serotonin. Glycerophospholipids metabolism, pentose and glucuronate interconversions, and pentose phosphate pathway were also greatly affected. These results suggest that anxiety can disturb three translation of material in ACS patients. Besides the above metabolism pathways pyrimidine metabolism was significantly disturbed. Based on the present findings the plasma metabolites monitoring can be recommended and may be conducive to early biomarkers detection for personalized treatment anxiety in CHD patients in future.

Coronary Heart Disease and Depression or Anxiety: A Bibliometric Analysis.

This study aimed to conduct a bibliometric analysis of published studies on the association between coronary heart disease (CHD) and depression or anxiety. The study also aimed to identify leading authors, institutions, and countries to determine research hotspots and obtain some hints from the speculated future frontiers. Publications about CHD and depression or anxiety between 2004 and 2020 were collected from the Web of Science Core Collection (WOSCC) database. Bibliographic information, such as authorship, country, citation frequency, and interactive visualization, was generated using VOSviewer1.6.16 and CiteSpace5.6.R5. In total, 8,073 articles were identified in the WOSCC database. The United States (2,953 publications), Duke University and Harvard University (214 publications), Psychosomatic Medicine (297 publications), and Denollet Johan. (99 publications) were the most productive country, institutions, journal, and author, respectively. The three hotspots of the research were “The relationship between depression and CHD,” “depression and myocardial infarction,” and “The characteristic of women suffering depression after MI.” The four future research frontiers are predicted to be “treating depression in CHD patients with multimorbidity,” “psychometric properties of instruments for assessing depression and anxiety in CHD patients,” “depression or anxiety in post-PCI patients,” and “other mental diseases in CHD patients.” Bibliometric analysis of the association between CHD and depressive disorders might identify new directions for future research.

Association of Apelin and Apelin Receptor Polymorphisms With the Risk of Comorbid Depression and Anxiety in Coronary Heart Disease Patients.

The Apelin (APLN)/apelin receptor (APLNR) signaling pathway is a newly identified regulator in various cardiovascular diseases, which is considered as a candidate pathway for the occurrence of coronary heart disease (CHD), depression, and anxiety. The goal of this study was to investigate the association between APLN/APLNR gene polymorphisms and the risk of depression and anxiety in CHD patients. To this end, a case-control study involving 269 CHD patients and 184 healthy control individuals was conducted. The 269 patients with CHD including 122 patients with and 147 patients without depression, and 56 patients with and 213 patients without anxiety Four single nucleotide polymorphisms were selected and successfully genotyped using Sanger sequencing. The APLN rs2235310T allele and APLNR rs9943582C allele were found to be associated with an increased risk of CHD after multiple test correction (P-adjust < 0.05). The patients with CHD who carried the rs9943582C allele had a higher risk of depression, after adjusting for alcohol drinking habits, insomnia, hypertension, and stroke history, with the Bonferroni correction (P-adjust = 0.018). The APLNR rs2282623 T allele was associated with an increased risk of anxiety in CHD patients after adjusting for related disease complications, with the Bonferroni correction (P-adjust = 0.022). We reported for the first time that the APLN rs2235310 and APLNR rs2282623 polymorphisms are associated with the risks of psychiatric disorders in CHD patients and may serve as novel biomarkers for therapy.

Psychometric Properties of Persian Version of Patient Health Questionnaires-4 (PHQ-4) in Coronary Heart Disease Patients

Background: Psychological factors, such as depression and anxiety are among the risk factors in coronary heart disease (CHD). Therefore, we need the necessary interventions in this field to quickly diagnose these disorders. Objectives: The aim of this study was to determine the psychometric properties of Patient Health questionnaires-4 (PHQ-4) as a screening tool for depression and anxiety in CHD patients in Iran. Methods: In this study, 279 CHD patients completed PHQ-4, Patient Health questionnaires-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) scale, and Beck depression inventory version-II (BDI-II). Semi-structured clinical interviews (SCID) based on DSM-5 were also used to diagnose depression and anxiety. Results: Cronbach’s alpha for PHQ-2, GAD-2, and PHQ-4 were reported to be 0.79, 0.75, and 0.78 respectively. The correlations of the PHQ-4 questionnaire with the BDI-II, GAD-7, GAD-2, PHQ-9, and PHQ-2 were found to be 0.72, 0.63, 0.85, 0.79, and 0.88 respectively. The results of fitting one-factor and two-factor models showed that the two-factor model has a more suitable fit. The optimal cut-off point of PHQ-4 ≥ 7 to measure depression and anxiety concurrently (sensitivity = 0.86, specificity = 0.90, and the area under the curve was 0.93 (CI = 0.90 - 0.96). Conclusions: The PHQ-4 questionnaire is an appropriate tool for diagnosis of and screening for depression and anxiety in the population of CHD patients.

Treatment of anxiety in patients with coronary heart disease: Rationale and design of the UNderstanding the benefits of exercise and escitalopram in anxious patients WIth coroNary heart Disease (UNWIND) randomized clinical trial

Anxiety is highly prevalent among patients with coronary heart disease (CHD), and there is growing evidence that high levels of anxiety are associated with worse prognosis. However, few studies have evaluated the efficacy of treating anxiety in CHD patients for reducing symptoms and improving clinical outcomes. Exercise and selective serotonin reuptake inhibitors have been shown to be effective in treating patients with depression, but have not been studied in cardiac patients with high anxiety. The UNWIND trial is a randomized clinical trial of patients with CHD who are at increased risk for adverse events because of comorbid anxiety. One hundred fifty participants with CHD and elevated anxiety symptoms and/or with a diagnosed anxiety disorder will be randomly assigned to 12 weeks of aerobic exercise (3×/wk, 35 min, 70%-85% VO2peak), escitalopram (5-20 mg qd), or placebo. Before and after 12 weeks of treatment, participants will undergo assessments of anxiety symptoms and CHD biomarkers of risk, including measures of inflammation, lipids, hemoglobin A1c, heart rate variability, and vascular endothelial function. Primary outcomes include post-intervention effects on symptoms of anxiety and CHD biomarkers. Secondary outcomes include clinical outcomes (cardiovascular hospitalizations and all-cause death) and measures of quality of life. The UNWIND trial (ClinicalTrials.gov NCT02516332) will evaluate the efficacy of aerobic exercise and escitalopram for improving anxiety symptoms and reducing risk for adverse clinical events in anxious CHD patients.

Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting

Previous studies in post-myocardial infarction patients with heart failure have documented that high anxiety levels are associated with increased mortality. In this prospective study, we determined the impact of anxiety on long-term event risk in stable coronary heart disease (CHD) patients treated with percutaneous coronary interventions (PCIs). A total of 470 patients referred for PCI completed the Hospital Anxiety and Depression Scale (HADS) before undergoing stent implantation. Over a five-year follow-up period, data on survival, occurrence of major adverse cardiovascular events (MACEs) and repeat revascularization were obtained from n = 462 participants (98.3%). All-cause mortality rates differed significantly across the four quartiles of the HADS anxiety subscale, the lowest number of deaths (1.9%) being seen in patients with the highest HADS-A quartile (scores ≥ 10) as compared to those in the three lower quartiles (11.8%, odds ratio = 0.14, 95%-confidence interval (95% CI): 0.03-0.60, p = 0.002). Cox regression models adjusted for a variety of potential somatic and procedural confounders confirmed the results from the univariate analyses (hazard ratio (HR) = 0.21, 95% CI: 0.05-0.91, p = 0.037). There were also fewer MACEs in anxious patients as compared to non-anxious subjects (HR = 0.34, 95% CI: 0.14-0.80, p = 0.014). In contrast, anxious patients had a higher rate of repeat revascularization (26.4% versus 16.6%, p = 0.033). In CHD patients undergoing elective PCI, higher anxiety levels are positively associated with survival and reduce the risk for MACE during the first five years after index PCI. The beneficial effects of anxiety on cardiovascular mortality and morbidity suggest that a differentiated approach to diagnosing and treating anxiety in CHD patients is warranted.

Depression, anxiety, and risk factor control in patients after hospitalization for coronary heart disease: the EUROASPIRE III Study

To assess in coronary heart disease (CHD) patients: (1) differences in the prevalence of depression and anxiety between samples selected from 22 countries; (2) the association of depression and anxiety with age, education, diagnostic category, favourable behaviours, use of cardioprotective drugs, and reaching the secondary prevention treatment targets. Cross-sectional study. The study group consisted of 8580 patients from 22 European countries examined at least 6 months after hospitalization due to CHD. Depression and anxiety were assessed using Hospital Anxiety and Depression Scale (HADS). Prevalence of depression (HADS depression score ≥ 8) varied from 8.2% to 35.7% in men and from 10.3% to 62.5% in women. Prevalence of anxiety (HADS anxiety score ≥ 8) varied from 12.0% to 41.8% in men and from 21.5% to 63.7% in women. Older age, female sex, low education, and no history of invasive treatment were associated with more frequent depression and anxiety. Depression and anxiety were associated with less frequent modification of lifestyle. Depression was related with body mass index, waist circumference, fasting glucose, and more frequent self-reported diabetes but not with reaching the treatment targets for blood pressure and lipids. High prevalence of depression and anxiety in CHD patients, and relation with less frequent lifestyle modification, call to integrate methods of identification and minimizing unfavourable effects of depression and anxiety into the cardiac rehabilitation and prevention programmes.

Social support and religiosity as coping strategies for anxiety in hospitalized cardiac patients

Prospective studies have demonstrated that anxiety is associated with an increased risk of mortality and sudden cardiac death. There is therefore a need to understand what factors contribute to anxiety in patients with coronary heart disease (CHD). This study examined whether social support and religiosity are individually or jointly associated with lower anxiety in cardiac patients. Anxiety, perceived social support, and religiosity were assessed in 228 (71% male, 29% female) hospitalized CHD patients aged 62 +- 11 years. Higher levels of social support were related to lower levels of state and trait anxiety (state anxiety, r = -.26, p < .01; trait anxiety, r = -.30, p < .01;). Religiosity was related to lower state anxiety (r = -.27, p < .01) but only modestly related to lower trait anxiety (trait anxiety, r = -.18, p < .01). The relationship between religiosity and trait anxiety was no longer significant after controlling for social support (p = .26). These findings suggest that religiosity and social support provide a buffer against anxiety in CHD patients and that higher levels of social support may account for the relationship between religiosity and trait anxiety. These findings underscore the importance of social support and religiosity as buffers against distress, with possible implications for prognosis in a patient group where high levels of anxiety appear to confer increased risk of mortality.