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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Anxiety Worsens Prognosis in Patients With Coronary Artery Disease

Woldecherkos A. Shibeshi, MD^_*,, Yinong Young-Xu, ScD, MS, MA^_* and Charles M. Blatt, MD, FACC^_*,,_*

^_* Lown Cardiovascular Research Foundation, Brookline, Massachusetts
Harvard Medical School, Boston, Massachusetts.

Manuscript received September 19, 2006; revised manuscript received January 19, 2007, accepted February 5, 2007.

^_* Reprint requests and correspondence: Dr. Charles M. Blatt, Lown Cardiovascular Center, 21 Longwood Avenue, Brookline, Massachusetts 02446. (Email: cblatt{at}partners.org).

Objectives: This study examined the effect of anxiety on mortality and nonfatal myocardial infarction (MI) in patients with coronary artery disease (CAD).

Background: Inconsistent data exist regarding the impact of anxiety on the prognosis of patients with CAD.

Methods: The authors conducted a prospective cohort study at an outpatient cardiology clinic of 516 patients with CAD (mean age 68 years at entry, 82% male) by administering the Kellner Symptom Questionnaire annually. The primary outcome was the composite of nonfatal MI or all-cause mortality.

Results: During an average follow-up of 3.4 years, we documented 44 nonfatal MIs and 19 deaths. A high cumulative anxiety score was associated with an increased risk of nonfatal MI or death. Comparing the highest to lowest tertile of anxiety score, the age-adjusted hazard ratio was 1.97 (95% confidence interval 1.03 to 3.78, p = 0.04). In a multivariate Cox model after adjusting for age, gender, education, marital status, smoking, hypertension, diabetes mellitus, previous MI, body mass index, and total cholesterol, each unit increase in the cumulative mean anxiety score was associated with increased risk of nonfatal MI or total mortality; the hazard ratio was 1.06 (95% confidence interval 1.01 to 1.12, p = 0.02).

Conclusions: A high level of anxiety maintained after CAD diagnosis constitutes a strong risk of MI or death among patients with CAD.

Abbreviations and Acronyms   CAD = coronary artery disease   CI = confidence interval   HR = hazard ratio   MI = myocardial infarction   SQ = The Kellner Symptom Questionnaire

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