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From the VA San Diego Healthcare System (T.R.), Department of Psychiatry (T.R., S.E.L.), University of California, San Diego, San Diego, California; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (S.E.L.), San Diego, California; Uniformed Services University of the Health Sciences (D.S.K., J.F.), Department of Medical and Clinical Psychology (B.D.J, W.E.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Medicine (V.B.), University of Alabama at Birmingham, Birmingham, Alabama; UCLA School of Nursing (J.-A.E.), Los Angeles, California; Department of Medicine (C.J.P.), University of Florida, Gainesville, Florida; Department of Medicine (V.V.), Emory University, Atlanta, Georgia; Department of Medicine (D.A.V.), Allegheny General Hospital, Pittsburgh, Pennsylvania; Department of Medicine (C.N.B.M.), Cedars-Sinai Medical Center, Los Angeles, California.
Address correspondence and reprint requests to Thomas Rutledge, Psychology Service 116B, VA San Diego Healthcare System, Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail: Thomas.Rutledge{at}va.gov
Objective: To study the independent and interactive effects of depression and anxiety symptoms as predictors of cardiovascular disease (CVD) events in a sample of women with suspected myocardial ischemia. Symptoms of depression and anxiety overlap strongly and are independent predictors of CVD events. Although these symptoms commonly co-occur in medical patients, little is known about combined effects of depression and anxiety on CVD risk.
Method: A total of 489 women completed a baseline protocol including coronary angiogram, CVD risk factor assessment, and questionnaire-based measures of depression and anxiety symptoms, using the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI), respectively. Participants were followed for a median 5.9 years to track the prevalence of CVD events (stroke, myocardial infarction, heart failure, and CVD-related mortality). We tested the BDI x STAI interaction effect in addition to the BDI and STAI main effects.
Results: Seventy-five women (15.3% of sample) experienced a CVD event, of which 18 were deaths attributed to cardiovascular causes. Results using Cox regression indicated a significant BDI x STAI interaction effect in the prediction of CVD events (p = .02) after covariate adjustment. Simple effect analyses indicated that depression scores were significant predictors of CVD events among women with low anxiety scores (hazard ratio [HR] = 2.3 [in standard deviation units]; 95% Confidence Interval [CI] = 1.3–3.9; p = .005) but not among women with higher levels of anxiety (HR = 0.99; 95% CI = 0.70–1.4; p = .95).
Conclusion: Among women with suspected myocardial ischemia, the value of depression symptoms for predicting CVD events varied by the severity of comorbid anxiety. These results suggest that the clinical utility of depression measures may be improved by using them in combination with measures of anxiety.
Key Words: depression • anxiety • cardiovascular disease • women • prospective
Abbreviations: WISE = Women's Ischemia Syndrome Evaluation; CVD = cardiovascular disease; CAD = coronary artery disease; GAD = generalized anxiety disorder; CHF = congestive heart failure; MI = myocardial infarction; BDI = Beck Depression Inventory; STAI = State Trait Anxiety Inventory.
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  P. J. Tully THEORIES OF DEPRESSION AND ANXIETY AND CARDIOVASCULAR OUTCOMES IN PSYCHOSOMATIC MEDICINE AND BEHAVIORAL CARDIOLOGY Psychosom Med, February 1, 2010; 72(2): 224 - 225. [Full Text] [PDF]
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