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Anxiety, anger and depressive symptoms linked to cardiovascular risk in patients with RA
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High levels of anxiety, anger and depressive symptoms were linked to a higher risk for developing cardiovascular events and subclinical atherosclerosis in patients with rheumatoid arthritis, but not in healthy control participants, according to the results of a study published in Arthritis Care and Research.
Researchers studied 195 patients with rheumatoid arthritis (RA) who attended the Johns Hopkins Arthritis Center between 2004 and 2006 and 1,073 healthy control participants recruited between 2000 and 2002.
Patients between the ages of 45 to 84 years were included after a diagnosis with RA according to the American College of Rheumatology (ACR) criteria at least 6 months prior to enrollment. Patients were excluded in the presence of prior history of CVD, implanted pacemaker or defibrillator device, current atrial fibrillation, body weight in excess of 300 pounds or CT chest scans performed within 6 months of study enrollment.
The Center for Epidemiologic Studies Depression Scale (CES-D) was used to screen patients for depressive symptoms and the Chronic Burden Scale was used to measure ongoing stress in personal healthcaregiver, relationship, job and financial stress. The Spielberger Trait Anxiety and Trait Anger scales used to measure the propensity for anxiety and levels of anger. The MOS Social Support Survey (modified) and the Perceived Discrimination and Everyday Hassles questionnaires were also administered.
Cardiac multidetector row CT scanning was performed on all participants and coronary artery calcium (CAC) was measured according to the Agatston method. A threshold of CAC above 100 was defined as moderate-to-severe coronary artery disease (CAD). Patients with RA were assessed for disease activity.
For each unit increase in anxiety scores, a 10% higher risk for CAC was seen in patients with RA only. Every unit increase in the anger score was associated with a 14% increased risk for CAC in patients with RA. For every unit increase on the CES-D score, the risk for CAC increased by 5% in patients with RA. Caregiver stress for patients with RA was correlated to double the risk for CAC, but levels of C-reactive protein or interleukin-6 did not significantly correlate with an increased risk.
“Our study shows that depression, stress, anxiety, and anger are associated with atherosclerosis markers, which are known predictors of cardiovascular risk in RA,” Ying Liu, MD, MPH, said in a press release. “These findings highlight the importance of screening and treatment of heart disease risks factors to limit not only health care costs, but prevent morbidity and mortality for RA patients.”– by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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