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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 - PowerPoint PPT Presentation
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Cardiovascular disease in a large cohort of depressed and/or anxious
patientsResults 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
2030 Disease % DALYs*1 Depression 9.6%2 Heart disease 5.9%3 Alzheimer,
dementia5.8%
4 Alcohol problems 4.7%5 Diabetes 4.5%6 Stroke 4.5%7 Hearing problems 4.1%8 Cancer 3.0%9 Arthritis 2.9%
10 Lung disease 2.5%
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
Depression as risk factor for CVDGeneral population
Proof from systematic reviews
Review #studies
# persons
RR
Rugulies, 2002 11 36 549 1.64
Wulsin, 2003 10 28 737 1.64
Nicholson, 2006 21 124 509 1.81
Van der Kooy, 2007 28 ±80 000 1.60
Rugulies Am J Prev Med 2002Wulsin & Singal Psychosom Med 2003Nicholson et al. Eur Heart J 2006Van der Kooy et al. Int J Geriatr Psychiatry 2007
Review # studies
#persons
RR
Barth, 2004 20 11 018 2.24
Van Melle, 2004 16 6 367 2.59
Nicholson, 2006 34 17 842 1.80
Barth et al. Psychosom Med 2004Van Melle et al. Psychosom Med 2004Nicholson et al. Eur Heart J 2006
Depression and CVD prognosisCVD patients
Proof from systematic reviews
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
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
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%)
Design & Sample NESDA
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
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
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
Baseline characteristics No CVD (n=2746) CVD (n=184)
p
Age (years) Women Education (years) No MDD (n=650)
Subthreshold depression Remitted MDD (n=680)
Current MDD (n=1204)
No anxiety (n=907)
Subthreshold anxiety Remitted anxiety (n=403)
Current anxiety (n=1333)
IDS BAI
41.2 (13.0)67.9
12.3 (3.2)22.813.323.040.831.89.6
13.844.8
21.1 (14.0)11.8 (10.5)
53.1 (8.9) 48.4
10.8 (3.1)12.516.3 26.145.117.913.012.5 56.5
26.4 (14.3)16.4 (11.2)
<.001<.001<.001 .01
<.001
<.001<.001
(n=396)
(n=287)
Adjusted OR for CVD
OR* 95% CI p MDD and anxiety in separate models
No MDD Subthreshold depression Remitted MDD Current MDD
1.931.842.21
REF1.07-3.491.07-3.141.33-3.67
.03
.03 .002
No anxiety Subthreshold anxiety Remitted anxiety Current anxiety
2.111.422.42
REF1.18-3.780.80-2.521.58-3.72
.01
.23<.001
* Adjusted for age, sex, education, smoking, alcohol use, and BMI
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
0
2
4
6
8
10
12
Normal< 14
1027
Mild14-25
813
V. severe≥ 49
114
Severe39-49
273
Moderate26-38
703
IDS:
N=
%withCVD
p <.001
3.6
7.66.4
9.9
11.4
CVD prevalence and severity of depression and anxiety symptoms
0
2
4
6
8
10
12
BAI:
N=
Normal< 10
1472
Mild10-18
757
Severe≥ 30
215
Moderate19-29
486
p <.001
3.8
7.5
9.910.7%
withCVD
Depression severity Anxiety severity
OR* 95% CI p MDD and anxiety in separate models
No MDD Subthreshold depression Remitted MDD Current MDD
1.931.842.21
REF1.07-3.491.07-3.141.33-3.67
.03
.03 .002
No anxiety Subthreshold anxiety Remitted anxiety Current anxiety
2.111.422.42
REF1.18-3.780.80-2.521.58-3.72
.01
.23<.001
* Adjusted for age, sex, education, smoking, alcohol use, and BMI
Depression or anxiety?Adjusted OR for CVD
Depression or anxiety?Adjusted OR for CVD
OR* 95% CI p MDD and anxiety in one model
No MDD Subthreshold depression Remitted MDD Current MDD
No anxiety Subthreshold anxiety Remitted anxiety Current anxiety
1.291.361.35
1.831.282.11
REF0.67-2.490.75-2.460.74-2.48
REF0.96-3.490.70-2.331.27-3.50
.46
.31
.33
.07
.43 .004
* Adjusted for age, sex, education, smoking, alcohol use, and BMI
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
Discussion
CVD was largely based on self-report
Link between anxiety and cardiovascular disease needs more attention