Psychological Distress and Subsequent Cardiovascular Events in Individuals With Coronary Artery Disease

• Type of Material: Article
• Authors: Pratik Pimple, Emory University; Bruno B. Lima, Emory University; Muhammad Hammadah, Emory University; Kobina Wilmot, Emory University; Ronnie Ramadan, Emory University; Oleksiy Levantsevych, Emory University; Samaah Sullivan, Emory University; Jeong Hwan Kim, Emory University; Belal Kaseer, Emory University; Amit J. Shah, Emory University; Laura Ward, Emory University; Paolo Raggi, Emory University; J. Douglas Bremner, Emory University; John Hanfelt, Emory University; Tene Lewis, Emory University; Arshed Ali Quyyumi, Emory University; Viola Vaccarino, Emory University
• Language: English
• Date: 2019-05-07
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.118.011866
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 8
• Issue: 9
• Start Page: e011866
• End Page: e011866
• Grant/Funding Information: This work was supported by the NIH, through the following grants: P01 HL101398, R01 HL109413, R01HL109413‐02S1, R01HL125246, K24HL077506, K24 MH076955, UL1TR000454, KL2TR000455, K23HL127251, and T32HL130025A.
• Keywords: latent class analysis; sex differences; women; cardiovascular disease; depression; psychological stress
• Research Categories: Biology, Biostatistics; Psychology, Behavioral; Health Sciences, Epidemiology

Abstract

Background Higher symptom levels of a variety of measures of emotional distress have been associated with cardiovascular disease ( CVD ), especially among women. Here, our goal was to investigate the association between a composite measure of psychological distress and incident cardiovascular events. Methods and Results In a prospective cohort study, we assessed 662 individuals (28% women; 30% blacks) with stable coronary artery disease. We used a composite score of psychological distress derived through summation of Z-transformed psychological distress symptom scales (depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress) as a predictor of an adjudicated composite end point of adverse events (cardiovascular death, myocardial infarction, stroke, heart failure, or unstable angina). During a mean follow-up of 2.8 years, 120 (18%) subjects developed CVD events. In the overall population, there was no association between the psychological distress measure and CVD events, but there was a sex-based interaction ( P=0.004). In women, higher psychological distress was associated with a higher incidence of CVD events; each SD increase in the composite score of psychological distress was associated with 1.44 times adjusted hazard of CVD events (95% CI, 1.09-1.92). No such association was found in men. Conclusions Among patients with coronary artery disease, higher psychological distress is associated with future cardiovascular events in women only.