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Cardiovascular disease in a large cohort of depressed and/or anxious patients

Cardiovascular disease in a large cohort of depressed and/or anxious patients. Results of the Netherlands Study of Depression and Anxiety. N Vogelzangs 1 , A Seldenrijk 1 , HPJ van Hout 2 , HWJ van Marwijk 2 , M Diamant 3 , BWJH Penninx 1

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Cardiovascular disease in a large cohort of depressed and/or anxious patients

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  1. Cardiovascular disease in a large cohort of depressed and/or anxious patients Results of the Netherlands Study of Depression and Anxiety N Vogelzangs1, A Seldenrijk1, HPJ van Hout2, HWJ van Marwijk2, M Diamant3, BWJH Penninx1 EMGO Institute and Department of 1Psychiatry, 2General Practice, 3Endocrinology, VU University Medical Center, Amsterdam, 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 patients recruited from community, primary care, and outpatient psychiatric clinics, and healthy controls • 2,981 persons; 1979 women (66%), 1002 men (34%)

  8. Psychopathology CIDI psychiatric interview (DSM-IV): • Presence & subtype • Major depressive disorder (MDD; single, recurrent) • Anxiety disorder (generalized anxiety disorder, social phobia, panic disorder and/or agoraphobia) • Recency: • Current: within last year • Remitted: lifetime, not current

  9. Psychopathology • Chronicity: • affected ≥ 50% of past 48 months, life chart • Severity: • Inventory of Depressive Symptoms (IDS), 0-84 • Beck Anxiety Inventory (BAI), 0-63 • Subthreshold: • Depression: no MDD + IDS ≥ 14 • Anxiety: no anxiety disorder + BAI ≥ 10

  10. Cardiovascular disease Coronary heart disease and/or stroke based on: • Self-report of myocardial infarction or angina pectoris supported by use of beta blockers or vasodilators (nitrates or calcium channel blockers) (n=129) • Self-report of coronary angioplasty or coronary artery bypass surgery (n=70) • Self-report of cerebrovascular disease (n=56) => Total N=184

  11. Baseline characteristics (n=287)

  12. Adjusted OR for CVD * Adjusted for age, sex, education, smoking, alcohol use, and BMI

  13. Depression and anxiety characteristics In multivariable regression analyses: • Chronicity of depression or anxiety was not associated with CVD prevalence • Subtype of depression (single/recurrent) or anxiety (social phobia, GAD, panic) was not associated with CVD prevalence

  14. CVD prevalence and severity of depression and anxiety symptoms Depression severity Anxiety severity 11.4 % with CVD 10.7 % with CVD p <.001 p <.001 9.9 9.9 7.6 7.5 6.4 3.6 3.8 IDS: N= Severe 39-49 273 V. severe ≥ 49 114 Normal < 14 1027 Mild 14-25 813 Moderate 26-38 703 BAI: N= Severe ≥ 30 215 Normal < 10 1472 Mild 10-18 757 Moderate 19-29 486

  15. Depression or anxiety?Adjusted OR for CVD * Adjusted for age, sex, education, smoking, alcohol use, and BMI

  16. Depression or anxiety?Adjusted OR for CVD * Adjusted for age, sex, education, smoking, alcohol use, and BMI

  17. Conclusions • Cardiovascular disease is more prevalent among depressed and/or anxious patients • This association was most strong for current anxiety • The highest CVD prevalence was found among those with the most severe anxiety and depressive symptoms

  18. Discussion • CVD was largely based on self-report • Link between anxiety and cardiovascular disease needs more attention

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