Relative importance of psychologic traits and severity of ischemia in causing angina during treadmill exercise

Davies, Richard F.; Linden, Wolfgang; Habibi, Habibullah; Klinke, W. Peter; Nadeau, Christine; Phaneuf, Denis; Lepage, Serge; Dessain, P; Buttars, Jennifer A.

doi:10.1016/0735-1097(93)90671-m

Cited by 37 publications

(12 citation statements)

References 35 publications

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“…34 Patients with severe multivessel or left main disease should be considered for CABG, 30 -31 whereas patients with less extensive disease should be treated with /3-blockers or calcium channel blockers 35 " 37 or angioplasty. 38 The results of ongoing studies comparing medical therapies for silent myocardial ischemia 22 ' 39 should be incorporated into this protocol as they become available. Recommendations regarding the cardiac evaluation of patients with carotid stenosis and no history of CAD who have a lower burden of risk factors than the patients in this trial…”

Section: Discussionmentioning

confidence: 99%

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Chimowitz

Weiss

Cohen

et al. 1994

Stroke

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Patients with carotid stenosis have a high frequency of asymptomatic coronary artery disease (CAD). The purpose of this study of patients with asymptomatic carotid stenosis was to test the hypothesis that patients without a history of CAD have the same cardiac prognosis as patients with a history of CAD. Men enrolled in the Department of Veterans Affairs study on the efficacy of carotid endarterectomy for asymptomatic carotid stenosis underwent a baseline cardiac evaluation (history, physical examination, and electrocardiogram) to document previous angina or myocardial infarction. Patients were randomized to medical therapy alone or medical therapy and carotid endarterectomy. Medical therapy consisted of aspirin 650 mg twice daily and treatment of risk factors. All episodes of angina, myocardial infarction, or sudden death during follow-up (average of 47.9 months) were recorded. Of 444 men enrolled in the study, 200 (45%) had a history of CAD. During the study 86 (43%) of 200 patients with CAD and 81 (33%) of 244 patients without a history of CAD had cardiac ischemic events (P = .03). In patients without a history of CAD, the first cardiac event was myocardial infarction or sudden death in 45 patients (56%). Factors that were independently associated with cardiac events in patients without a history of CAD were diabetes (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.15 to 3.97), intracranial occlusive disease (OR, 2.13; 95% CI, 1.13 to 4.02), and peripheral vascular disease (OR, 2.04; 95% CI, 1.14 to 3.66). Forty-two percent of patients with two of these factors and 69% of patients with all three factors had cardiac events. Men with carotid stenosis and no history of CAD have a lower rate of cardiac events than men with carotid stenosis who have a history of CAD. However, a subgroup of patients with carotid stenosis and no history of CAD who have coexistent intracranial occlusive disease, diabetes, or peripheral vascular disease have a risk of cardiac events similar to that of patients with a history of CAD.

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Section: Discussionmentioning

confidence: 99%

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Chimowitz

Weiss

Cohen

et al. 1994

Stroke

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“…A variety of psychological characteristics have also been found to be associated with reporting, or denying, anginal symptoms [10–24], or with clinical manifestations of disturbed ischemic pain perception/coping such as treatment seeking delay during acute myocardial infarction [25], silent myocardial infarction [26, 27], or unheralded sudden cardiac death [28]. It is difficult to compare these studies because they are not entirely consistent with respect to the psychological variables that were included, or the methods and measures used.…”

Section: Introductionmentioning

confidence: 99%

Symptoms of Anxiety and Depression Are Correlates of Angina Pectoris by Recent History and an Ischemia-Positive Treadmill Test in Patients with Documented Coronary Artery Disease in the Pimi Study

Ketterer

Bekkouche

Goldberg

et al. 2011

Cardiovascular Psychiatry and Neurology

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Objective. We tested the association of specific psychological characteristics in patients having stable coronary disease with the reporting of anginal symptoms during daily activities, and positive exercise testing. Methods. One hundred and ninety-six patients with documented CAD enrolled in the Psychophysiological Investigations of Myocardial Ischemia (PIMI) Study completed an anginal history questionnaire and a battery of psychometric tests. They also underwent standardized exercise treadmill tests. Results. Patients with a recent history of angina were more likely to be female, and had higher Beck Depression (P = .002), State Anxiety (P = .001), Trait Anxiety (P = .03), Harm Avoidance (P = .04) and Muscle Tension (P = .004) scores than patients who had no recent history of angina. Along with several treadmill variables indicating more severe disease state and reduced exercise tolerance, patients who developed angina on a positive treadmill test also displayed higher scores on the Beck Depression Inventory (P = .003) and State Anxiety (P = .004) scales. Conclusions. Several psychological characteristics, and most notably anxiety and depression, are strong correlates of recent angina and angina in the presence of ischemia provoked by treadmill testing.

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“…Anxiety, another measure of NA, has been linked to higher reports of chest pain among cardiac and non-cardiac populations (25,26). In contrast, patients with silent ischemia (no chest pain) appear to have lower levels of depression and anxiety (27).…”

Section: Introductionmentioning

confidence: 93%

Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia

et al. 2017

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Relative importance of psychologic traits and severity of ischemia in causing angina during treadmill exercise

Cited by 37 publications

References 35 publications

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Symptoms of Anxiety and Depression Are Correlates of Angina Pectoris by Recent History and an Ischemia-Positive Treadmill Test in Patients with Documented Coronary Artery Disease in the Pimi Study

Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia

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