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Anxiety confers higher risk for ischemia in women
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In women without a history of CAD, those who had anxiety were more likely to exhibit ischemia on a single-photon emission CT exercise stress test than those who did not, according to new findings. The same was not true for men or for mood disorders.
Researchers performed SPECT exercise stress testing on 2,342 participants (760 women) to determine the presence of ischemia. The PRIME-MD interview was administered to all participants to assess for mood and anxiety disorders.
The goal was to determine a relationship between mood or anxiety disorders and myocardial ischemia, with the cohort stratified by sex and by history of CAD.
Women had greater prevalence than men of any psychiatric disorder (OR = 1.76), any anxiety disorder (OR = 1.78), any mood disorder (OR = 1.62) and the combination of anxiety and mood disorders (OR = 1.85), but men had greater prevalence than women of ischemia (OR = 3.63), Nicola J. Paine, PhD, from the department of exercise science, Concordia University, Montréal, and Montréal Behavioural Medicine Centre, Hôpital du Sacré-Coeur à Montréal, and colleagues wrote.
In those without history of CAD, the researchers observed a sex by anxiety interaction with ischemia (beta = –0.83; P = .015), and a sex by comorbid anxiety and mood interaction with ischemia (beta = –1.2; P = .005). In those with a history of CAD, there was no interaction between any psychiatric disorder, sex and ischemia.
According to Paine and colleagues, among women with no CAD history, those with anxiety were more likely to show ischemia on a stress test than those without anxiety (OR = 1.75; 95% CI, 1.05-2.89). However, there was not a similar relationship in men with no CAD history (OR = 1.31; 95% CI, 0.83-2.06).
In women with a history of CAD, there was no relationship between anxiety and risk for ischemia (OR = 0.99; 95% CI, 0.42-2.34), according to the findings.
“In our study, women who had an anxiety disorder had increased presentation of ischemia during stress testing and, given that ischemia is related to a doubling in the risk of adverse CAD events, this may, in part, explain the anxiety-CAD relationship and sex disparity in CAD outcomes,” Paine and colleagues wrote. “Anxiety may not only mask real symptoms of CAD, but also exacerbate symptoms, through psychophysiological pathways such as autonomic dysregulation, that could further put anxiety disorder patients at risk.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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