Cardiovascular disease in persons with depressive and anxiety disorders

Background: Associations between depression, and possibly anxiety, with cardiovascular disease have been established in the general population and among heart patients. This study examined whether cardiovascular disease was more prevalent among a large cohort of depressed and/or anxious persons. In addition, the role of specific clinical characteristics of depressive and anxiety disorders in the association with cardiovascular disease was explored. Methods: Baseline data from the Netherlands Study of Depression and Anxiety were used, including persons with a current ( i.e. past year) or remitted DSM-IV depressive or anxiety disorder (N = 2315) and healthy controls (N = 492). Additional clinical characteristics (subtype, duration, severity, and psychoactive medication) were assessed. Cardiovascular disease (stroke and coronary heart disease) was assessed using algorithms based on self-report and medication use. Results: Persons with current anxiety disorders showed an about three-fold increased prevalence of coronary heart disease (OR anxiety only = 2.70, 95%CI = 1.31-5.56; OR comorbid anxiety/depression = 3.54, 95%CI = 1.79-6.98). No associations were found for persons with depressive disorders only or remitted disorders, nor for stroke. Severity of depressive and anxiety symptoms but no other clinical characteristics most strongly indicated increased prevalence of coronary heart disease. Limitations: Cross-sectional design. Conclusions: Within this large psychopathology-based cohort study, prevalence of coronary heart disease was especially increased among persons with anxiety disorders. Increased prevalence of coronary heart disease among depressed persons was largely owing to comorbid anxiety. Anxiety alone as well as comorbid to depressive disorders as risk indicator of coronary heart disease deserves more attention in both research and clinical practice. (C) 2010 Elsevier B.V. All rights reserved.