Acute Ischemic Heart Disease
Association of anxiety with reduced baroreflex cardiac control in patients after acute myocardial infarction*,**,

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Abstract

Background Although depression has been associated with increased mortality in patients after acute myocardial infarction (AMI), little is known about the effects of depression on autonomic nervous system control of heart rate. This study evaluated whether depression is associated with impaired baroreflex sensitivity (BRS) in patients with AMI. Methods Two hundred four hospitalized patients with AMI were evaluated 6 ± 3 (mean ± SD) days after AMI. BRS was assessed using cross-spectral analysis to measure baroreceptor-mediated R-R interval oscillations. Depression was determined using the Diagnostic Interview Schedule, and severity of depressive symptoms was measured with the Beck Depression Inventory. In order to adjust for possible differences in anxiety, we also measured state anxiety using the Spielberger State Anxiety Inventory. Results Depression was not significantly related to BRS. However, anxiety was significantly related to low BRS in multivariate analysis, after the potentially confounding variables of age, blood pressure, and respiratory frequency were controlled for. Comparison of groups with high and low anxiety (on the basis of a median split of state anxiety scores) showed that BRS was reduced by approximately 20% in the patients with the higher anxiety scores (4.7 ± 3.2 ms/mm Hg vs 5.7 ± 3.3 ms/mm Hg, P <.05), after adjustment for differences in age, blood pressure, and respiratory frequency. Conclusions High levels of anxiety, but not depression, are associated with reduced vagal control in patients after AMI. (Am Heart J 2002;143:460-6.)

Section snippets

Patients

Patients were invited to participate in this study if they showed evidence of AMI based on a greater than twofold increase in cardiac enzymes with either somatic symptoms or electrocardiographic changes characteristic of AMI (ST-segment changes or new Q waves). All patients were tested while taking their prescribed medications. Patients were excluded if they were not currently in normal sinus rhythm or if they were unable to complete the required diagnostic interview because of severe physical

Effects of depression diagnosis

Eighteen percent of the patients with AMI met the modified criteria for MDD. Clinical and demographic characteristics of patients with MDD and those without MDD are shown in Table I.

. Demographic and clinical characteristics of study groups

Empty CellPatients without depressionPatients with depression
N16737
Sex58% Men60% Men
Race62% White76% White
Age (y)59 ± 1156 ± 13
BDI score7 ± 621 ± 10***
State anxiety score31 ± 1040 ± 12***
BMI (kg/m2)28.3 ± 5.230.9 ± 10.9*
Current smokers53%81%**
SBP (mm Hg)126 ± 20123 ± 15

Discussion

We found no evidence for a relationship between depression and impaired autonomic control in patients with AMI. These findings are similar to those in studies of depressed psychiatric patients that did not find a relationship between depressive symptoms and heart rate variability12, 13, 14 or BRS.15 However, other studies in psychiatric patients41, 42 and in patients with stable CAD9, 10 have observed lower levels of heart rate variability and lower BRS11 in depressed patients compared with

Acknowledgements

We thank Dr Norman Anderson for providing the Finapres blood pressure monitor used in this study. We also thank Drs Elizabeth Jackson, Virginia Wadley, and Teri Baldewicz for confirming the diagnoses of MDD in the patients.

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    *

    Guest Editor for this manuscript was Mark A. Hlatky, MD, Stanford University School of Medicine, Stanford, Calif.

    **

    This study was supported by funds from the National Institutes of Health (Grants U01-HL58946-04, HL-60826, HL-59672, and HC-55142).

    Reprint requests: Dr Lana Watkins, Department of Psychiatry and Behavioral Sciences, Box 3119, Duke University Medical Center, Durham, NC 27710. E-mail: [email protected]

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