Although attention has recently been focused on the role of psychosocial factors in
patients with cardiovascular disease (CVD), the factors that have the greatest influence
on prognosis have not yet been elucidated. The aim of this study was to evaluate the
effects of depression, anxiety, and anger on the prognosis of patients with CVD. Four
hundred fourteen consecutive patients hospitalized with CVD were prospectively enrolled.
Depression was evaluated using the Patient Health Questionnaire, anxiety using the
Generalized Anxiety Disorder Questionnaire, and anger using the Spielberger Trait
Anger Scale. Cox proportional-hazards regression was used to examine the individual
effects of depression, anxiety, and anger on a combined primary end point of cardiac
death or cardiac hospitalization and on a combined secondary end point of all-cause
death or hospitalization during follow-up (median 14.2 months). Multivariate analysis
showed that depression was a significant risk factor for cardiovascular hospitalization
or death after adjusting for cardiac risk factors and other psychosocial factors (hazard
ratio 2.62, p = 0.02), whereas anxiety was not significantly associated with cardiovascular
hospitalization or death after adjustment (hazard ratio 2.35, p = 0.10). Anger was
associated with a low rate of cardiovascular hospitalization or death (hazard ratio
0.34, p <0.01). In conclusion, depression in hospitalized patients with CVD is a stronger
independent risk factor for adverse cardiac events than either anxiety or anger. Anger
may help prevent adverse outcomes. Routine screening for depression should therefore
be performed in patients with CVD, and the potential effects of anger in clinical
practice should be reconsidered.
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Article info
Publication history
Published online: February 22, 2013
Accepted:
January 21,
2013
Received in revised form:
January 21,
2013
Received:
November 5,
2012
Footnotes
This study was supported by Science Research Grant H21-KOKORO-IPPAN-007 (Research on Psychiatric and Neurological Disease and Metal Health) from Japan's Ministry of Health, Labour and Welfare, Tokyo, Japan.
See page 1436 for disclosure information.
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© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
