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CORONARY ARTERY DISEASE PATIENTS WITH CONCURRENT PSYCHIATRIC DISORDERS AT GREATER RISK FOR MORTALITY
35 JACC March 21, 2017 Volume 69, Issue 11
Acute and Stable Ischemic Heart Disease CORONARY ARTERY DISEASE PATIENTS WITH CONCURRENT PSYCHIATRIC DISORDERS AT GREATER RISK FOR MORTALITY Moderated Poster Contributions Acute and Stable Ischemic Heart Disease Moderated Poster Theater, Poster Hall, Hall C Sunday, March 19, 2017, 1:15 p.m.-1:25 p.m. Session Title: New Perspectives on CAD Risk Factors Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1319M-09 Authors: Chantel Johnson, Thomas Allison, Karina Gonzalez Carta, Howard University College of Medicine, Washington, DC, USA, Mayo Clinic, Rochester, MN, USA Background: Psychiatric disorders and mood changes are commonly observed in patients with coronary artery disease (CAD). More specifically, patients with CAD have been shown to exhibit increased instances of anger, hostility, social isolation, stress, anxiety, sleep disturbances, and depression. The current study aimed to explore the association between psychiatric disorders (PsyD) with common cardiovascular comorbidities and to determine the effect of PsyD on mortality in patients with CAD.
Methods: In order to develop our study cohort, 1994-2010 data from the Mayo Clinic stress test database was reviewed. We included patients with a history of coronary artery disease who performed non-imaging exercise tests. Non-Minnesota residence and age < 30 were exclusion criteria. Comorbidities included obesity, hypertension, diabetes and current smoking by self-report. PsyD was defined as either a psychiatric diagnosis in the medical record or taking a psychoactive drug. Mortality was determined from Mayo Clinic records and Minnesota Death Index through January 2016.
Results: A total of 5363 patients with coronary artery disease were included in this historical-prospective study. PsyD was defined in 804 patients (15%). Patients with PsyD were slightly younger (61 ± 11 vs. 63 ± 11 years, P < .001) and more likely female (30 vs. 20%, P < .0001). The rates of comorbidities were: diabetes (20 vs 16%, P < .005), hypertension (52 vs. 47%, P < .008), obesity (41 vs. 35%, P < .004) and current smoking (10 vs. 7%, P < .0007). PsyD patients also had poor exercise capacity (75 vs. 84% predicted, P < .0001). There were 2041 deaths (38%) over a mean follow-up of 11.9 ± 5.6 years. Following adjustment for age, sex, and comorbidities, the hazards ratio for PsyD was 1.52 with 95% CL [1.34 - 1.73], P < .0001. Addition of exercise capacity to the model only slightly attenuated the risk of PsyD to 1.39 [1.22 - 1.58], P < .0001. Conclusions: PsyD is a significant risk factor for mortality in patients with established CAD. This effect cannot be explained by increased comorbidities. Patients with PsyD also show reduced exercise capacity, but this only partially accounts for the increased mortality risk.
Acute and Stable Ischemic Heart Disease CORONARY ARTERY DISEASE PATIENTS WITH CONCURRENT PSYCHIATRIC DISORDERS AT GREATER RISK FOR MORTALITY Moderated Poster Contributions Acute and Stable Ischemic Heart Disease Moderated Poster Theater, Poster Hall, Hall C Sunday, March 19, 2017, 1:15 p.m.-1:25 p.m. Session Title: New Perspectives on CAD Risk Factors Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1319M-09 Authors: Chantel Johnson, Thomas Allison, Karina Gonzalez Carta, Howard University College of Medicine, Washington, DC, USA, Mayo Clinic, Rochester, MN, USA Background: Psychiatric disorders and mood changes are commonly observed in patients with coronary artery disease (CAD). More specifically, patients with CAD have been shown to exhibit increased instances of anger, hostility, social isolation, stress, anxiety, sleep disturbances, and depression. The current study aimed to explore the association between psychiatric disorders (PsyD) with common cardiovascular comorbidities and to determine the effect of PsyD on mortality in patients with CAD.
Methods: In order to develop our study cohort, 1994-2010 data from the Mayo Clinic stress test database was reviewed. We included patients with a history of coronary artery disease who performed non-imaging exercise tests. Non-Minnesota residence and age < 30 were exclusion criteria. Comorbidities included obesity, hypertension, diabetes and current smoking by self-report. PsyD was defined as either a psychiatric diagnosis in the medical record or taking a psychoactive drug. Mortality was determined from Mayo Clinic records and Minnesota Death Index through January 2016.
Results: A total of 5363 patients with coronary artery disease were included in this historical-prospective study. PsyD was defined in 804 patients (15%). Patients with PsyD were slightly younger (61 ± 11 vs. 63 ± 11 years, P < .001) and more likely female (30 vs. 20%, P < .0001). The rates of comorbidities were: diabetes (20 vs 16%, P < .005), hypertension (52 vs. 47%, P < .008), obesity (41 vs. 35%, P < .004) and current smoking (10 vs. 7%, P < .0007). PsyD patients also had poor exercise capacity (75 vs. 84% predicted, P < .0001). There were 2041 deaths (38%) over a mean follow-up of 11.9 ± 5.6 years. Following adjustment for age, sex, and comorbidities, the hazards ratio for PsyD was 1.52 with 95% CL [1.34 - 1.73], P < .0001. Addition of exercise capacity to the model only slightly attenuated the risk of PsyD to 1.39 [1.22 - 1.58], P < .0001. Conclusions: PsyD is a significant risk factor for mortality in patients with established CAD. This effect cannot be explained by increased comorbidities. Patients with PsyD also show reduced exercise capacity, but this only partially accounts for the increased mortality risk.