The interaction between anxiety and depressive symptoms on brachial artery reactivity in cardiac patients

Anxiety and Depression Scores in Patients Subjected to Arterial Revascularization for Critical Limb Ischemia

OBJECTIVES

This study aims to examine the changes in anxiety and depression scores in 138 patients with critical limb ischemia (rest pain or gangrene) who had no previous psychiatric history, at 30 days and 6 months after surgical revascularization.

METHODS

Patients were submitted to a questionnaire-based evaluation using the Beck Anxiety and Depression Inventories before surgery (no more than three days before surgery) ("Pre-Op"), 30 days after surgical revascularization ("Early PO") and at least 6 months after surgical revascularization ("Late PO"). The cut-off scores for depression were (1) < 10, no depression or minimal depression; (2) 10‒18, mild to moderate depression; (3) 19‒29, moderate to severe depression; and (4) 30‒63, severe depression. The cut-off scores for anxiety were (1) < 8, no anxiety or minimal anxiety; (2) 8‒15, mild anxiety; (3) 16‒25, moderate anxiety; and (4) 26‒63, severe anxiety.

RESULTS

No perioperative mortality was observed 30 days after surgical revascularization. Thirty-nine (28.2%) patients underwent major (above-ankle) amputation within 30 days. Mean anxiety and depression scores, respectively, declined from 12.48 ± 9.74 (mean ± SD) and 16.92 ± 12.48 preoperatively to 4.89 ± 7.04 and 6.52 ± 9.36 postoperatively (P<0.001, both). Anxiety and depression scores were not significantly affected by preoperative comorbidities (systemic arterial hypertension, diabetes mellitus, previous stroke, and smoking), affected arterial territory (aortoiliac, femoropopliteal, or infrapopliteal), or surgical technique (open surgery vs endovascular therapy). Only patients undergoing amputation within 30 days showed no improvement in depressive symptoms.

CONCLUSIONS

Patients with critical limb ischemia have a high incidence of anxiety and depressive symptoms, which improve considerably after successful surgical revascularization. Major amputation was associated with a lack of improvement in depression scores. A formal psychiatric evaluation may be beneficial in patients who show no improvement in depressive symptoms.

The effect of treatment response on endothelial function and arterial stiffness in depression. A prospective study

BACKGROUND

Major depression is associated with endothelial dysfunction and arterial stiffening, which may mediate development of hypertension and increased cardiovascular risk. The effect of response to antidepressant treatment on these vascular parameters has not been elucidated.

AIMS

We aimed to assess the net effect of antidepressant therapy on endothelial function and arterial stiffness in patients with psychotic depression.

METHOD

Thirty-seven patients with major psychotic depression, according to DSM-IV-TR, were treated with titrated citalopram 20-60 mg and risperidone 0.5-1 mg and were followed for 6 months. Twelve additional patients who denied treatment, or were non-compliant, were also followed for the same time period. Vascular function was assessed by flow-mediated dilatation (FMD), carotid-femoral pulse wave velocity (PWV) and augmentation index (AI), at baseline and at the end of follow-up.

RESULTS

Aortic and peripheral blood pressure (BP), PWV, FMD and AI (p < 0.05 for all) were significantly improved in the group that received treatment. Overall, only responders to treatment (n = 24) presented significant improvements in all hemodynamic and vascular parameters (p < 0.05 for all), irrespectively of traditional cardiovascular risk factors (TRFs), vasoactive medication and BP lowering. In a secondary analysis, patients with psychotic depression presented worse endothelial function as compared to controls matched for TRFs.

LIMITATIONS

Non-randomized study.

CONCLUSIONS

Patients who respond to therapy for major psychotic depression present sustained improvement in vascular function. Given that depressed patients are considered to be at high cardiovascular risk and are often non-compliant with treatment, further research to assess cardiovascular benefits of vigilant monitoring of antidepressant therapy is warranted.

The relationship of depressive symptoms and functional and structural markers of subclinical atherosclerosis: A systematic review and meta-analysis

Objectives

The relationship of depressive symptoms and subclinical atherosclerosis remains controversial. We performed a systematic review and meta-analysis to evaluate the effect of depressive symptoms on the functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and flow-mediated vasodilation (FMD).

Methods

A systematic literature search was performed electronically. Studies relating IMT, PWV or FMD to depressive symptoms were included. Standard/weighted mean differences (SMD/WMD) and corresponding 95% confidence intervals (95% CIs) were pooled in overall and subgroup analyses (age, sex, depression diagnosis, region, study design, site measured and sample size). Sensitivity analysis and publication bias were also conducted.

Results

Thirty-eight articles involving 5947 patients with depressive symptoms and 34,423 controls without depressive symptoms were included. Compared with controls without depressive symptoms, patients with depressive symptoms showed a significantly thicker IMT (SMD (95% CI) = 0.137 (0.047–0.227), p = 0.003), a higher PWV (SMD (95% CI) = 0.216 (0.139–0.293), p < 0.001) and a lower FMD (WMD (95% CI) = –2.554 (–3.709 to –1.399), p < 0.001). When analyzing subgroups with age and female ratio, all results were still significant ( p < 0.05) except IMT and FMD in age < 50 years subgroups ( p > 0.05). There was no statistical significance in sensitivity analysis and publication bias ( p > 0.05).

Conclusions

Depressive symptoms contributed toward subclinical atherosclerosis, and resulted in impaired functional and structural markers of subclinical atherosclerosis, which holds great promise in early prevention of cardiovascular disease.

Anxiety Disorders and Cardiovascular Disease

Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. Anxiety disorders are associated with the onset and progression of cardiac disease, and in many instances have been linked to adverse cardiovascular outcomes, including mortality. Both physiologic (autonomic dysfunction, inflammation, endothelial dysfunction, changes in platelet aggregation) and health behavior mechanisms may help to explain the relationships between anxiety disorders and cardiovascular disease. Given the associations between anxiety disorders and poor cardiac health, the timely and accurate identification and treatment of these conditions is of the utmost importance. Fortunately, pharmacologic and psychotherapeutic interventions for the management of anxiety disorders are generally safe and effective. Further study is needed to determine whether interventions to treat anxiety disorders ultimately impact both psychiatric and cardiovascular health.