30 Jun 2009

Anxiety, depression up angina risk

Michael Jackson’s death and rumours of Joost van der Westhuizen suffering from heart troubles have highlighted the effect anxiety and depression can have on the heart, as is shown in a new study.

The study showed that among patients with a similar degree of inducible chest pain, anxiety and depression are associated with a statistically significant increase in the frequency of angina.

"These results support the study of angina treatment strategies that aim to reduce psychosocial distress" as well as lessen the symptoms, the study team concludes in a report published in the rapid access issue of Circulation: Journal of the American Heart Association.

Angina is chest pain that typically occurs in response to activity or stress, which may feel like tightness, heavy pressure, squeezing or crushing pain, which usually begins slowly and worsens over the next few minutes before going away. It may quickly go away with medication or rest, but may happen again with additional activity or stress.

Symptoms of angina occur when the coronary arteries are narrowed or blocked by hardening of the arteries (atherosclerosis), or by a blood clot. This results in ischaemia, as not enough blood reaches the tissues, they are starved of oxygen eventually die.

How the study was done
"American cardiology has focused almost exclusively on reducing ischaemia in its treatments of angina...but this study suggests that we should also assess and treat depression and anxiety in patients with frequent angina," said senior author Dr Mark Sullivan, of the University of Washington School of Medicine, Seattle. "British and European cardiology does more of this."

Sullivan and colleagues studied 191 patients (average age, 63 years) with ischaemia using myocardial stress perfusion imaging studies performed between April 2004 and 2006.

Using the Seattle Angina Questionnaire, they determined that 68 patients (36%) had no angina in the previous month, 66 (35%) had monthly angina symptoms, and 57 (30%) had daily or weekly angina.

Sullivan's team also determined that 44% of patients with daily or weekly angina had clinically significant anxiety, and 64% had clinically significant depression.

What the study revealed
After further analysis, increasing angina was significantly associated with a history of coronary surgery (2.24-times the risk), anxiety (4.72-times the risk), and depression (3.12-times the risk).

The results suggest that psychosocial characteristics are related to the frequency of angina, independent of the severity of the angina, the investigators note. However, "it is unclear whether these psychosocial factors are truly affecting the anginal response to ischaemia or if the increased chest pain burden is causing intensification in psychosocial distress," Sullivan added. – (Reuters Health, June 2009)