TUCSON – Can patients with generalized anxiety disorder get so anxious that they are literally scared to death?
Evidently so, according to findings from the large prospective Heart and Soul Study.
Dr. Alan J. Gelenberg
The cohort study involved 1,015 San Francisco Bay area outpatients with stable coronary heart disease prospectively followed for a mean of 5.6 years. A total of 371 acute myocardial infarctions, strokes, and other cardiovascular events occurred during 5,711 person-years of follow-up, Dr. Alan J. Gelenberg reported at the annual psychopharmacology review sponsored by the University of Arizona.
The age-adjusted cardiovascular event rate in the 106 Heart and Soul participants with baseline generalized anxiety disorder (GAD) was 9.9%, significantly greater than the 6.6% rate in those without GAD.
After adjustment for potential confounding variables, including major depression and other comorbid conditions, patient demographics, cardiac disease severity, and medication use, GAD remained independently associated with a highly significant 74% increased cardiovascular event rate (Arch. Gen. Psychiatry 2010;67:750-8).
The study serves as one example of the substantial morbidity and mortality associated with GAD.
Major depression, too, has been shown to be a strong predictor of cardiovascular mortality. Indeed, in a classic French Canadian study of 896 post-MI patients, the single greatest predictor of cardiac death over the next 5 years – stronger, for example, than left ventricular ejection fraction, diabetes, or a history of prior MI – was a patient’s score on the Beck Depression Inventory during the acute MI hospitalization (Circulation 2002;105:1049-53), noted Dr. Gelenberg, professor and chair of the department of psychiatry at Pennsylvania State University, Hershey.
Both GAD and depression kill in another way: suicide, the eighth-leading cause of death in the United States. GAD has been shown in several studies to increase suicide risk in adults, and in the Great Smoky Mountains Study, the combination of GAD and current depression was associated with a substantially increased risk of suicidality in teenagers, Dr. Gelenberg observed.
In various studies, 8%-19% of patients hospitalized for major depressive disorder eventually committed suicide, he added.
The Heart and Soul Study was funded by the Department of Veterans Affairs; the National Heart, Lung, and Blood Institute; and several foundations. Dr. Gelenberg said he had no relevant financial disclosures.