NEW ORLEANS — Anxiety and other forms of psychological distress constitute a potent independent risk factor for development of new-onset atrial fibrillation in patients with chronic stable coronary artery disease, Charles M. Blatt, M.D., reported at the annual scientific sessions of the American Heart Association.
The relationship is dose dependent. The higher a CAD patient's level of anxiety, depression, somatization, or hostility, the greater the long-term risk of developing atrial fibrillation (AF), said Dr. Blatt of Harvard Medical School, Boston, and director of research at the Lown Cardiovascular Research Foundation, Brookline, Mass.
He reported on 354 men and 95 women with chronic stable CAD who were followed prospectively for an average of 5 years. Participants are being assessed annually for psychological distress using the 92-item Kellner's Symptom Questionnaire.
The incidence of AF in patients in the lowest Kellner quartile for total psychological distress was 2 cases per 1,000 person-years, compared with 16 cases per 1,000 person-years in the highest quartile.
After adjustment for standard AF risk factors, including gender and age, patients in the second through fourth quartiles for anxiety level had a 2.1-fold greater risk of developing AF for each quartile increase.
For depression, each quartile increase was associated with a 1.7-fold greater risk of developing AF, compared with that of patients in the lowest quartile. AF risk increased by an additional 50% with each step up from the second through fourth quartiles of somatization, and by 60% with each increase in quartiles for hostility.
Patients in the second quartile for total psychological distress had an adjusted 2.3-fold increased risk of developing atrial fibrillation, compared with those in the lowest quartile. Those in the third quartile had an adjusted 4.6-fold increased risk, while patients in the fourth quartile had a 6.9-fold greater risk than those in the first quartile, according to Dr. Blatt.