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Cardiovascular disease in persons with anxiety or depressive disorders

Cardiovascular disease in persons with anxiety or depressive disorders. Nicole Vogelzangs 1,2 , Adrie Seldenrijk 1,2 , Aartjan TF Beekman 1,2 , Hein PJ van Hout 1,3 , Peter de Jonge 4 , Brenda WJH Penninx 1,2 Journal of Affective Disorders, Epub

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Cardiovascular disease in persons with anxiety or depressive disorders

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  1. Cardiovascular disease in persons with anxiety or depressive disorders Nicole Vogelzangs1,2, Adrie Seldenrijk1,2, Aartjan TF Beekman1,2, Hein PJ van Hout1,3, Peter de Jonge4, Brenda WJH Penninx1,2 Journal of Affective Disorders, Epub 1 EMGO Institute and Department of 2 Psychiatry, 3General Practice, VU University Medical Center, Amsterdam, The Netherlands 4 Department of Psychiatry, University Medical Center Groningen, The Netherlands

  2. Burden of disease in Western countries * DALYs = disability-adjusted life years = lost life years + lost quality of life WHO: Mathers et al. Plos Medicine 2006

  3. Depression as risk factor for CVD General population Proof from systematic reviews Rugulies Am J Prev Med 2002 Wulsin & Singal Psychosom Med 2003 Nicholson et al. Eur Heart J 2006 Van der Kooy et al. Int J Geriatr Psychiatry 2007

  4. Depression and CVD prognosis CVD patients Proof from systematic reviews Barth et al. Psychosom Med 2004 Van Melle et al. Psychosom Med 2004 Nicholson et al. Eur Heart J 2006

  5. Relatively unknown • Prevalence of CVD in population of depressed and anxious persons • Association anxiety disorders and CVD • Which characteristics of depression and anxiety are linked with CVD

  6. Netherlands Study of Depression and Anxiety www.nesda.nl funded through the mental health program of the Netherlands Organization for Health Research (ZonMW) and matching funds from participating institutes

  7. Design & Sample NESDA • Design • Naturalistic cohort study • Baseline assessment and follow-up assessments after 1, 2, 4, 6, 8 years • Sample • Depressed and/or anxious persons (18-65 years) from community, primary care, and outpatient psychiatric clinics (n=2329) and healthy controls (n=652) • 2981 persons; 1979 women (66%), 1002 men (34%)

  8. Sample selection • Exclusion of • persons with depressive or anxiety symptoms but no diagnosis (subthreshold symptoms; n=158) • Persons with self-reported CVD without heart medication (n=16) => 2807

  9. Psychopathology CIDI psychiatric interview (DSM-IV) • Presence (& subtype), current (1 year) or remitted: • Depressive disorder (dysthymia, major depressive disorder [MDD; single, recurrent]) • Anxiety disorder (generalized anxiety disorder, social phobia, panic disorder and/or agoraphobia) • Additional subtype specifiers • Late age of onset (≥ 30 years) • Atypical symptoms (based on IDS) • Melancholic symptoms (based on IDS)

  10. Clinical characteristics • Duration: • % of time affected of past 48 months, life chart • Severity: • Inventory of Depressive Symptoms (IDS), 0-84 • Beck Anxiety Inventory (BAI), 0-63 • Psychoactive medication: • Selective serotonin reuptake inhibitor (SSRI) • Tricyclic antidepressant (TCA) • Other antidepressant • Benzodiazepine

  11. Cardiovascular disease • Stroke and/or coronary heart disease (CHD): • self-report of stroke supported by use of anticoagulant, antiplatelet, antihypertensive or lipid modifying agent; • self-report of myocardial infarction or angina pectoris (symptoms) supported by use of beta blocker, nitrate vasodilator, calcium channel blocker, anticoagulant or antiplatelet agent; • self-report of coronary angioplasty or bypass surgery.

  12. Baseline characteristics

  13. Adjusted OR for CVD * Adjusted for age, sex, education, smoking, alcohol use, physical activity and BMI

  14. Adjusted OR for stroke and CHD * Adjusted for age, sex, education, smoking, alcohol use, physical activity and BMI

  15. OR* for CHD in persons with a current depressive and/or anxiety disorder OR 2.40 1.77 Current depressive disorder N = 418 Current anxiety disorder N = 504 Current depressive and anxiety disorder N = 848 * Adjusted for age, sex, education

  16. Depression and anxiety characteristics and CHD * Per SD increase, adjusted for age, sex, education

  17. Conclusions • Coronary heart disease is more prevalent among depressed and particularly anxious persons • The association of depression with CHD was largely owing to comorbidity with anxiety • The highest CHD prevalence was found among those with the most severe anxiety and depressive symptoms

  18. Discussion • Cross-sectional design • No effects of symptom duration on CHD risk • CHD also increased among those with disorder onset before 30 years • Anxiety (alone or comorbid to depression) as risk indicator for CHD deserves more attention in research as well as clinical care

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