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Double Trouble: Clinical and Psychological Characteristics in SCAD With and Without Fibromuscular Dysplasia
Lisa-Marie Maukel1, Laurie-Anne Boivin-Proulx1, Jacqueline Saw2
1University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Insights
Spontaneous coronary artery dissection (SCAD) patients with fibromuscular dysplasia (FMD) are older, more often female, and experience higher psychological distress. Early screening for FMD and psychological support is crucial for this subgroup.
Area of Science:
- Cardiology
- Vascular Medicine
- Psychology
Background:
- Spontaneous coronary artery dissection (SCAD) is a significant cause of acute coronary syndrome, primarily affecting women and often linked to substantial psychological distress.
- Fibromuscular dysplasia (FMD), a nonatherosclerotic vascular disorder, frequently co-occurs with SCAD, complicating clinical management and potentially intensifying patient distress.
- Limited research exists on the specific patient characteristics differentiating SCAD patients with and without co-occurring FMD.
Purpose of the Study:
- To compare the demographic, clinical, and psychological profiles of SCAD patients diagnosed with and without fibromuscular dysplasia.
- To identify distinct characteristics associated with SCAD patients who also have FMD.
- To understand the impact of a co-occurring FMD diagnosis on psychological distress in SCAD patients.
Main Methods:
- A multicenter study involving SCAD patients diagnosed within the last three years.
- Chart review for medical data, including screening for FMD, and completion of sociodemographic questionnaires.
- Administration of validated psychological measures: Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Cardiac Anxiety Questionnaire (CAQ), and PTSD Checklist-5 (PCL-5).
Main Results:
- Of 326 participants, 128 (43.2%) met diagnostic criteria for FMD after screening.
- SCAD patients with FMD were older, more frequently female, and reported a higher incidence of migraines compared to those without FMD.
- Among patients aware of their FMD diagnosis, significantly higher rates of depression (32.8% vs 20.8%), anxiety (31.3% vs 17.4%), cardiac anxiety (64.2% vs 49.2%), and post-traumatic stress (25.4% vs 11.6%) were observed (all P < 0.05).
Conclusions:
- SCAD patients with a concomitant FMD diagnosis present with unique characteristics and report significantly elevated psychological distress.
- The findings underscore the necessity for early and comprehensive screening for both FMD and psychological distress in SCAD patients.
- Anticipatory psychological support and tailored interventions are recommended for SCAD patients with FMD due to the potential for increased psychological burden associated with the FMD diagnosis.
Background:
Spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome predominantly affecting women, is associated with substantial psychological distress. Fibromuscular dysplasia (FMD), a nonatherosclerotic vascular disorder frequently associated with SCAD, adds clinical complexity and may exacerbate distress. However, differences in patient characteristics between SCAD patients with and without FMD remain poorly studied.
Objectives:
The objective of the study was to compare demographic, clinical, and psychological characteristics of SCAD patients with and without FMD.
Methods:
In this multicenter study, SCAD patients diagnosed <3 years prior underwent chart review for medical data, including FMD screening. Participants completed sociodemographic questionnaires and validated psychological measures: Patient Health Questionnaire-9 (depressive symptoms), Generalized Anxiety Disorder-7 (generalized anxiety), Cardiac Anxiety Questionnaire (cardiac anxiety), and Post-traumatic Stress Disorder Checklist-5 (post-traumatic stress). Between-group differences were analyzed using t-tests and chi-square tests.
Results:
Of 326 participants, 296 (90.8%) completed FMD screening, with 128 (43.2%) meeting the diagnostic criteria. Compared to those without FMD, patients with FMD were older, more often females, and more likely to have a history of migraines. Among 67 patients aware of their FMD diagnosis, psychological distress was higher than in those without known FMD: depression 32.8% vs 20.8%, anxiety 31.3% vs 17.4%, cardiac anxiety 64.2% vs 49.2%, and post-traumatic stress 25.4% vs 11.6% (all P < 0.05).
Conclusions:
SCAD patients who receive a concomitant FMD diagnosis exhibit distinct characteristics and substantially higher psychological distress, highlighting the need for early, comprehensive screening for both FMD, and psychological distress. Given that FMD diagnosis itself may increase psychological burden, anticipatory psychological support and tailored interventions are warranted for this high-risk subgroup.
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