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Persistent psychological distress and mortality in patients with stable coronary artery disease

Ralph A H Stewart1, David M Colquhoun2, Simone L Marschner3

  • 1Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Auckland, New Zealand.

Heart (British Cardiac Society)
|June 28, 2017
PubMed

Insights

Persistent psychological distress, including depression and anxiety, significantly increases mortality risk in coronary heart disease patients. Mild or intermittent distress does not show the same association with cardiovascular or all-cause death.

Area of Science:

  • Cardiology
  • Psychology
  • Public Health

Background:

  • Psychological distress, encompassing depression and anxiety, is linked to higher mortality in coronary heart disease (CHD) patients.
  • The impact of persistent distress symptoms on long-term outcomes in CHD is not well-established.

Purpose of the Study:

  • To investigate the association between intermittent and persistent psychological distress and long-term cardiovascular (CV) and total mortality.
  • To analyze these associations in patients with stable coronary artery disease.

Main Methods:

  • Utilized data from 950 participants in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) trial.
  • Assessed psychological distress using the General Health Questionnaire (GHQ-30) at baseline and at 0.5, 1, 2, and 4 years.
  • Employed Cox proportional hazards models for landmark analysis from year 4, evaluating mortality risk based on distress severity and persistence over a median of 12.1 years.

Main Results:

  • Persistent moderate or greater psychological distress (GHQ score >10 on ≥3 occasions) was linked to significantly higher CV death (adjusted HR 3.94) and all-cause mortality (adjusted HR 2.85).
  • Patients with persistent mild distress (GHQ score >5 on ≥3 occasions) or intermittent distress (on 1-2 occasions) did not show an increased risk of mortality.
  • 3.7% of subjects reported persistent moderate or greater distress, while 7.7% reported persistent mild distress.

Conclusions:

  • Persistent psychological distress of at least moderate severity is a significant risk factor for increased CV and all-cause mortality in stable coronary artery disease patients.
  • The findings highlight the importance of addressing persistent, moderate-to-severe psychological distress in managing patients with coronary artery disease.
Abstract

Keywords:
anxietycoronary heart diseasedepressionpsychological distress

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