Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: a five year longitudinal cohort study

Abstract

BackgroundAlthough depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level.MethodsBefore coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease.ResultsIn the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 % of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 % confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 % CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 % CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE.ConclusionsGeneralized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.

Anxiety Disorders and Cardiovascular Disease

“…Though one study found that GAD was protective in the post-ACS period [21], most studies suggest that GAD is associated with poor cardiac health in all stages of CAD [22-24]. Following myocardial infarction (MI), GAD has been linked to a nearly two-fold increased risk of mortality over the subsequent ten years [23], and in patients with stable CAD, GAD is associated with a two-fold increased risk of major adverse cardiac events over the next two years [22].…”

“…Following myocardial infarction (MI), GAD has been linked to a nearly two-fold increased risk of mortality over the subsequent ten years [23], and in patients with stable CAD, GAD is associated with a two-fold increased risk of major adverse cardiac events over the next two years [22]. In a prospective study of 158 patients undergoing CABG surgery, GAD was associated with incident major adverse cardiac events over the subsequent 5 years [24]. The associations between GAD and outcomes in HF have not yet been studied.…”

Anksioznost in koronarna bolezen srca

“…Je napovedni dejavnik za slabšo napoved izida (32). Bolniki z anksioznostjo pred posegom so imeli večje tveganje za smrtnost (32,33), subjektivno poslabšanje, senzorično bolečino in telesne simptome 12 mesecev po operaciji (34). Pooperativna anksioznost naj bi bila prav tako dejavnik tveganja za višjo smrtnost, akutni miokardni infarkt in ponavljajoče se hospitalizacije (34,35).…”

Hostility, Anxiety and Vital Exhaustion in Myocardial Infarction Pathogenesis

“…Было включено 142 пациента (сред-рисков развития ОКС было ОР=1,52 (95% ДИ 1,36-1,71) по показателю тревоги, независимо от других факторов риска [2]. Риск "больших нежелательных сердечно-сосудистых событий" (МАСЕ) повыша-ется при наличии тревоги после операции аорто-коронарного шунтирования (ОР=2,79; 95% ДИ 1,00-7,80) (Tully, et al, 2015) [3]. Belan, et al (2015) также указывают на неблагоприятное влияние ситуатив-ной тревожности у пациентов после аорто-коронар-ного шунтирования [4].…”