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Depressed patients have more frequent chest pain even in the absence of coronary artery disease

London, UK – 31 Aug 2015: Depressed patients have more frequent chest pain even in the absence of coronary artery disease, according to results from the Emory Cardiovascular Biobank presented at ESC Congress today by Dr Salim Hayek, a cardiologist at Emory University School of Medicine in Atlanta, Georgia, US.1 The findings suggest that pain and depression may share a common neurochemical pathway.

Ischemic Heart Disease and Acute Cardiac Care
Cardiovascular Nursing


EMBARGO : 31 August 2015 at 13:00 BST

“Depression is a common and well recognised risk factor for the development of heart disease,” said Dr Hayek. “Patients with known heart disease and depression tend to experience chest pain more frequently. However until now, it was not known whether that association was dependent on underlying coronary artery disease.”2-4

The current study assessed whether depression was associated with chest pain independently of underlying coronary artery disease. The study included 5 825 adults enrolled in the Emory Cardiovascular Biobank between 2004 and 2013. The biobank is a prospective registry of patients undergoing cardiac catheterization at three Emory Healthcare sites in Atlanta.

Patients had an average age of 63 years, 65% were male and 22% were African Americans. Prior to cardiac catheterization patients completed the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms and the Seattle Angina Questionnaire to assess chest pain frequency in the past month. The presence and severity of coronary artery disease was determined by angiogram. Patients completed the same questionnaires at one and five years post-procedure.

The researchers found that depression severity as measured by the PHQ-9 was independently associated with the frequency of chest pain, indicating that patients with more severe depression had more frequent chest pain. Even patients with mild depression had more frequent chest pain than patients with no depressive symptoms. The findings remained after adjusting for coronary artery disease severity, age, gender, race and traditional cardiovascular risk factors including smoking status, body mass index, blood pressure and blood lipid levels.

Patients with depression, whether women or men, were three times more likely to experience more frequent chest pain than those without depression. This was found to be true in patients with and without obstructive coronary artery disease.

A reduction in the severity of depression symptoms was associated with a decrease in the frequency of chest pain at follow-up. Most importantly, patients with depression who underwent revascularization did not have an improvement in chest pain frequency at 1 year follow-up.

“We found that depression is strongly associated with the frequency of chest pain in adults with and without underlying coronary artery disease, and that patients with depression and heart disease did not have an improvement in their chest pain frequency even after coronary intervention” said Dr Hayek.

“One possible explanation for our findings is that pain and depression share a common neurochemical pathway.”5 He added: “Although depression is established as a risk factor for heart disease, there are no clear recommendations in the US for depression screening in patients with cardiovascular disease.6 ESC prevention guidelines recommend assessing patients for depression to prevent cardiovascular disease.7

Although our findings do not establish causality, they do suggest that depression is an important confounder of the relationship between chest pain and heart disease. Screening for depression in patients presenting with chest pain should be considered, and studies examining the effect of appropriate anti-depressive therapy on chest pain are needed.”

Dr Hayek concluded: “The fact that chest pain frequency at follow-up was decreased in patients whose depressive symptoms improved indicates that treating depression may help alleviate chest pain, after obstructive coronary artery disease as a cause of chest pain has been ruled out. This needs to be confirmed in randomised controlled trials.”

ENDS

References

1Dr Hayek will present the abstract ‘Depression is the strongest predictor of angina and is independent of underlying coronary artery disease severity in patients with cardiovascular disease’ during:
•    The press conference ‘Life Threatening Scenarios’ on Monday 31 August at 13:00
•    Best Posters session 5: Best Posters in coronary artery disease and comorbidities on Monday 31 August at 14:00 at the Best poster screen in the
2Rozanski A, Gransar H, Kubzansky LD et al. Do psychological risk factors predict the presence of coronary atherosclerosis? Psychosomatic medicine. 2011;73:7-15.
3Trivedi R, Gerrity M, Rumsfeld JS et al. Angina symptom burden associated with depression status among veterans with ischemic heart disease. Annals of Behavioral Medicine. 2015;49:58–65.
4Ketterer MW, Bekkouche NS, Goldberg AD, et al. Symptoms of anxiety and depression are correlates of angina pectoris by recent history and an ischemia-positive treadmill test in patients with documented coronary artery disease in the Pimi study. Cardiovascular Psychiatry and Neurology. 2011.
5Goesling J, Clauw DJ, Hassett AL. Pain and depression: an integrative review of neurobiological and psychological factors. Current Psychiatry Reports. 2013;15:421.
6Lichtman JH, Froelicher ES, Blumenthal JA et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014;129:1350-1369.
7Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). European Heart Journal. 2012 ;33 :1635–1701. doi:10.1093/eurheartj/ehs092


  

Notes to editor

SOURCES OF FUNDING: Dr Hayek is supported by the Katz Family Foundation Preventive Cardiology Grant (Atlanta, GA).
DISCLOSURES: None.

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This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2015. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.