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Mental distress may increase risk for CV events
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A new study highlights a strong, dose-dependent association between psychological distress and increased risk for MI and stroke in adults aged 45 years and older.
“Our study adds further weight to an increasing body of evidence highlighting the negative impact of poor mental health on physical health and suggests that this link may be partly, but not solely, explained by factors such as lifestyle and presence of other diseases,” Caroline A. Jackson, PhD, Chancellor’s Fellow at the University of Edinburgh, told Cardiology Today.
Jackson and colleagues analyzed data from 221,677 participants with no history of stroke or MI who were recruited for the New South Wales 45 and Up study from 2006 to 2009. In total, 102,039 were men (mean age, 62 years) and the rest were women (mean age, 60 years).
The researchers calculated psychological distress, including fatigue, anxiety, depression and hopelessness, among each participant within the previous 4 weeks using the 10-item Kessler Psychological Distress Scale. Psychological distress was categorized as low (score ≤ 15), moderate (16 to 21), high (22 to 29) or very high (30 to 50).
At the start of the study, 16.2% of participants had moderate psychological distress and 7.3% had high or very high psychological distress. Women had a greater likelihood of psychological distress compared with men (moderate, 17.3% vs. 14.8%; high/very high, 8.1% vs. 6.3%; P < .001).
Participants were followed for a mean of 4.7 years, during which 4,573 MIs and 2,421 strokes occurred.
The absolute risk for MI and stroke was higher with increasing psychological distress level. Among men aged 45 to 79 years, those with high or very high psychological distress had a 30% greater risk for MI compared with those with lower psychological distress (HR = 1.3; 95% CI, 1.12-1.51). The researchers noted a weaker association between elevated psychological distress and MI among participants aged 80 years and older. Among women, those with high or very high psychological distress had an 18% greater risk for MI compared with those with lower psychological distress (HR = 1.18; 95% CI, 0.99-1.42). The finding in women was similar in all age groups. Among those aged 45 to 79 years, presence of high or very high psychological distress was associated with a 24% (HR = 1.24; 95% CI, 0.97-1.59) increased risk for stroke in men and 44% (HR = 1.44; 95% CI, 1.09-1.92) increased risk in women.
“Among those aged 45 to 79 years, we observed a supra-additive interaction between psychological distress and male sex on MI risk (ie, the joint effect of psychological distress and male sex on MI risk was greater than we would expect). Among women, the magnitude of effect of psychological distress appeared greater for stroke than for MI. Furthermore, associations generally persisted despite adjustment for a wide range of confounding factors.
“To our knowledge, this is by far the largest study of psychological distress and incident CVD, including [more than four times] the number of MIs and double the number of strokes included in previous published studies combined,” Jackson and colleagues wrote in Circulation: Cardiovascular Quality and Outcomes.
These findings suggest a need for clinicians to proactively screen for symptoms of depression and anxiety and also screen for known CV risk factors in people with symptoms of depression and anxiety.
“Since the observed link between symptoms of poor mental health and heart attack and stroke was partly explained by lifestyle factors, positive health behaviors should be central to all health promotion messages, particularly among those with symptoms of psychological distress,” Jackson said. – by Melissa J. Webb
For more information:
Caroline A. Jackson, PhD, can be reached at caroline.jackson@ed.ac.uk.
Disclosures: The study was funded by a grant from the University of Queensland. The authors report no relevant financial disclosures.
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