Depression and Anxiety Screens as Predictors of 8-Year Incidence of Myocardial Infarction and Stroke in Primary Care Patients. Issue 5 (June 2016)

• Record Type: Journal Article
• Authors: Stewart, Jesse C.; Hawkins, Misty A.W.; Khambaty, Tasneem; Perkins, Anthony J.; Callahan, Christopher M.
• Is Part Of: Psychosomatic medicine. Volume 78:Issue 5(2016)
• Publication Date: 2016-06
• Subjects: anxiety -- depression -- myocardial infarction -- stroke -- primary care -- prospective -- CI = confidence interval -- CPT = Current Procedural Terminology -- CVD = cardiovascular disease -- ICD-9 = International Classification of Diseases, 9th Revision -- IMPACT = Improving Mood-Promoting Access to Collaborative Treatment -- HR = hazard ratio -- MI = myocardial infarction -- PRIME-MD = Primary Care Evaluation of Mental Disorders; Medicine, Psychosomatic -- Periodicals; 616.0805
• DOI: 10.1097/PSY.0000000000000315
• Languages: English
• ISSNs: 0033-3174

Abstract

ABSTRACT: Objective: Because depression and anxiety are typically studied in isolation, our purpose was to examine the relative importance of these overlapping emotional factors in predicting incident cardiovascular disease (CVD). Methods: We examined depression and anxiety screens, and their individual items, as predictors of incident hard CVD events, myocardial infarction, and stroke for 8 years in a diverse sample of 2041 older primary care patients initially free of CVD. At baseline, participants completed self-report depression and anxiety screens. Data regarding CVD events were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytic files. Results: During follow-up, 683 (33%) experienced a CVD event. Cox proportional hazards models—adjusted for demographic and CVD risk factors—revealed that a positive anxiety screen, but not a positive depression screen, was associated with an increased risk of a hard CVD event in separate models (Years 0–3: anxiety hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.21−1.96, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.81−1.21), p = .93; depression HR = 1.10, CI = 0.88−1.36, p = .41), as well as when entered into the same model (Years 0–3: anxiety HR = 1.53, CI = 1.20−1.95, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.80−1.21, p = .99; depression HR = 1.03, CI = 0.82−1.29, p = .82). Analyses examining individual items and secondary outcomes showed that the anxiety-CVD association was largely driven by the feeling anxious item and the myocardial infarction outcome. Conclusions: Anxiety, especially feeling anxious, is a unique risk factor for CVD events in older adults, independent of conventional risk factors and depression. Anxiety deserves increased attention as a potential factor relevant to CVD risk stratification and a potential target of CVD primary prevention efforts.