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CLINICAL STUDY: CORONARY ARTERY DISEASE

History of anxiety disorders is associated with a decreased likelihood of angiographic coronary artery disease in women with chest pain: the WISE study

Thomas Rutledge, PhD^*, Steven E. Reis, MD, FACC^*, Marian Olson, MS^*, Jane Owens, PhD^*, Sheryl F. Kelsey, PhD^*, Carl J. Pepine, MD, FACC, Nathaniel Reichek, MD, FACC, William J. Rogers, MD, FACC, C. Noel Bairey Merz, MD, FACC^||, George Sopko, MD^¶, Carol E. Cornell, PhD, Barry Sharaf, MD, FACC^# and Karen A. Matthews, PhD^*

^* University of Pittsburgh, Pittsburgh, Pennsylvania, USA
University of Florida, Gainesville, Florida, USA
Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
University of Alabama, Birmingham, Alabama, USA
^|| Cedars-Sinai Medical Center, Los Angeles, California, USA
^¶ National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
^# Rhode Island Hospital, Providence, Rhode Island, USA

Manuscript received June 2, 2000; revised manuscript received September 22, 2000, accepted November 3, 2000.

Reprint requests and correspondence: Dr. Thomas Rutledge, c/o WISE Coordinating Center, 127 Parran Hall, 130 DeSoto Street, Pittsburgh, Pennsylvania 15261
dr.tom{at}musclemail.com

OBJECTIVES

We sought to evaluate the ability of psychiatric anxiety-disorder history to discriminate between women with and without angiographic coronary artery disease (CAD) in a population with chest pain.

BACKGROUND

A total of 435 women with chest pain underwent a diagnostic battery including coronary angiography in order to improve testing guidelines for women with suspected CAD.

METHODS

Women referred for coronary angiography completed questionnaires assessing prior treatment history for anxiety disorder and current anxiety-related symptoms. Analyses controlled for standard CAD risk factors.

RESULTS

Forty-four women (10%) reported receiving prior treatment for an anxiety disorder. This group acknowledged significantly higher levels of autonomic symptoms (e.g., headaches, muscle tension [F = 25.0, p < 0.001] and higher behavioral avoidance scores (e.g., avoidance of open places or traveling alone by bus [F = 4.2, p < 0.05]) at baseline testing compared with women without prior anxiety problems. Women with an anxiety-disorder history did not differ from those without such a history with respect to the presence of inducible ischemia or use of nitroglycerin, although they were younger and more likely to describe both "tight" and "sharp" chest pain symptoms and to experience back pain and episodes of nocturnal chest pain. Logistic regression results indicated that the positive-anxiety-history group was more likely to be free of underlying significant angiographic CAD (odds ratio = 2.74, 95% confidence interval 1.15 to 6.5, p = 0.03).

CONCLUSIONS

Among women with chest pain symptoms, a history of anxiety disorders is associated with a lower probability of significant angiographic CAD. Knowledge of anxiety disorder history may assist in the clinical evaluation of women with chest pain.

Abbreviations and Acronyms   BDI = Beck Depression Inventory   CAD = coronary artery disease   DSM-IV = Diagnostic and Statistical Manual of Mental Disorders   HDL-C = high density lipoprotein cholesterol   LDL-C = low density lipoprotein cholesterol   MAPQ = Modified Autonomic Perception Questionnaire   WISE = Women’s Ischemia Syndrome Evaluation

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