Psychological Distress and the Risk of Adverse Cardiovascular Outcomes in Patients With Coronary Heart Disease
Mariana Garcia1, Kasra Moazzami1, Zakaria Almuwaqqat1
1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
High psychological distress in coronary heart disease (CHD) patients significantly increases adverse event risk. This distress index also improves cardiovascular risk prediction models, highlighting its clinical importance.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Psychological distress is a known risk factor for coronary heart disease (CHD).
- The clinical significance and predictive value of psychological distress in CHD patients remain unclear.
Purpose of the Study:
- To determine if psychological distress independently predicts adverse outcomes in CHD patients.
- To assess the contribution of psychological distress to cardiovascular risk prediction models.
Main Methods:
- Pooled analysis of 891 patients with stable CHD from two prospective cohorts.
- A composite psychological distress score was created using depression, anxiety, anger, perceived stress, and PTSD measures.
- Study endpoint: cardiovascular death, nonfatal myocardial infarction, or heart failure hospitalization over 5.9 years.
Main Results:
- Patients in the highest distress tertile had a 2.27-fold increased risk of adverse events compared to the lowest tertile.
- The middle distress tertile showed a 1.52-fold increased risk.
- Adding the distress score to traditional risk models significantly improved risk prediction metrics (C-statistic, NRI, IDI).
Conclusions:
- A composite measure of psychological distress is significantly linked to increased adverse event risk in CHD patients.
- Psychological distress significantly enhances the predictive accuracy of cardiovascular risk models.
Background:
Psychological distress is a recognized risk factor in patients with coronary heart disease (CHD), but its clinical significance is unclear.
Objectives:
The purpose of this study was to determine if an index of psychological distress is independently associated with adverse outcomes and significantly contributes to risk prediction.
Methods:
Pooled analysis of 2 prospective cohort studies of patients with stable CHD (N = 891). A psychological distress score was constructed using measures of depression, anxiety, anger, perceived stress, and post-traumatic stress disorder, measured at baseline. The study endpoint included cardiovascular death or first or recurrent nonfatal myocardial infarction or hospitalization for heart failure at 5.9 years.
Results:
In both cohorts, first and recurrent events occurred more often among those in the highest tertile of distress score than those in the lowest tertile. After combining the 2 cohorts, compared with the lowest tertile, the hazards ratio for having a distress score in the highest tertile was 2.27 (95% CI: 1.69-3.06), and for the middle tertile, it was 1.52 (95% CI: 1.10-2.08). Adjustment for demographics and clinical risk factors only slightly weakened the associations. When the distress score was added to a traditional clinical risk model, C-statistic, net reclassification index, and integrative discrimination index all significantly improved.
Conclusions:
Among patients with CHD, a composite measure of psychological distress was significantly associated with an increased risk of adverse events and significantly improved risk prediction.
Related Concept Videos
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:20Psychological Responses to Stress
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:30Stress and Mental Health
Individuals with depression often experience challenges in both their personal and professional...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...