Anxiety, Depression Interfere with Preventive Actions to Reduce CVD Risk Factors

Lukasz Pietrzykowski

Credit: ResearchGate

Anxiety and depression may interfere with preventative measures taken to eliminate or reduce the cardiovascular disease (CVD) risk, a study found.¹

“It is worth noting that a higher risk of CVD as measured by SCORE2 and SCORE2-OP was found in subjects with symptoms of anxiety and depression in both HADS subscales,” wrote investigators, led by Lukasz Pietrzykowski and Agata Kosobucka-Ozdoba, both from the department of cardiac rehabilitation and health promotion at Nicolaus Copernicus University in Poland.

People with unhealthy behaviors, such as a sedentary lifestyle, inappropriate eating habits, nicotinism, and increased alcohol consumption, have an increased CVD risk. These unhealthy lifestyle choices are also risk factors for anxiety and depression. Likewise, new research found anxiety and depression are also risk factors for CVD.

People can take measures to reduce their CVD risk, such as quitting tobacco smoking, reducing salt in their diet, eating more fruit and vegetables, regular exercise, and avoiding the harmful use of alcohol.² Investigators sought to see how anxiety and depression interfered with these preventative measures.¹ The team conducted a cross-sectional study aiming to assess the relationship between anxiety, depression, and the control of cardiovascular risk factors.

The study included 200 patients without symptomatic atherosclerotic cardiovascular disease, with a median age of 52 years (range: 18 – 80 years). Participants were diagnosed 6 – 24 months before study enrollment with either hypertension, diabetes, or hypercholesterolemia, based on ESC guidelines, and received pharmacological treatment for their condition in the same time frame.

Investigators assessed the control of the following basic CVD risk factors: blood pressure, body mass index (BMI), waist circumference, physical activity, smoking status, low-density lipoprotein cholesterol, total cholesterol, triglycerides, and blood glucose. They compared how many risk factors were controlled and the percentage of participants who reached the therapeutic goal for each cardiovascular risk factor.

The criteria for risk factor control were:

• Systolic blood pressure: <140 mmHg and diastolic blood pressure <90 mmHg
• BMI: 20.0–24.9 kg/m2
• Waist circumference: <80 cm for women and <94 cm for men
• Regular physical activity: intense physical activity for 20 minutes or more at least 1 –2 times a week
• No smoking status: A confirmed concentration of carbon monoxide in exhaled air ≤10 ppm
• Low-density lipoprotein cholesterol: <100 mg/dl (<2.6 mmol/l)
• Triglycerides: <150 mg/dl (<1.7 mmol/l)
• Fasting glucose: <100 mg/dl (<5.6 mmol/l)

The team assessed CVD risk with SCORE2 and SCORE2-OP. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). On HADs subscales for anxiety and depression, participants could get normal, borderline, and abnormal scores.

The median number of controlled CVD risk factors was 4, with an interquartile range of 3 – 5, and the median CVD risk was 3% (IQR, 1.5 – 7.0%). Participants had median HADS scores of 3 for the anxiety subscale (IQR, 2.0 – 6.0) and 3 for the depression subscale (IQR, 1.0 – 5.0).

Ultimately, participants with anxiety (P = .0072) and depression (P = .0177) had the greatest CVD risk. Additionally, participants with symptoms of anxiety and depression had significantly fewer controlled risk factors (HADS Anxiety: P = .0014; HADS Depression: P = .0304).

A lower percentage of participants with anxiety and depression had a normal waist circumference (HADs Anxiety: P = .0464; HADS Depression: P = .0200) and regular physical activity (HADS Anxiety: P = .0431; HADS Depression: P = .0055). Furthermore, a lower percentage of participants with anxiety had a normal BMI (P = .0218) and normal triglyceride concentrations (P = .0278).

Investigators said the study was limited by the relatively small sample, a lack of long-term follow-up, the imprecise definitions of physical activity, the wide age range of participants, the lack of complete data to perform the SCORE2-Diabetes algorithm in diabetic patients, and the absence of instrumental screening for asymptomatic CVD.

“The presence of anxiety and depression may affect the achievement of therapeutic goals in terms of controlling the basic CVD risk factors in individuals without a history of atherosclerotic CVD,” investigators concluded. “Therefore, assessment of anxiety and depression symptoms should be part of a comprehensive examination not only of patients with CVD but also those with high CVD risk.”

References

1. ^{Pietrzykowski Ł, Kosobucka-Ozdoba A, Michalski P, et al. The Impact of Anxiety and Depression Symptoms on Cardiovascular Risk Factor Control in Patients Without a History of Atherosclerotic Cardiovascular Disease. Vasc Health Risk Manag. 2024;20:301-311. Published 2024 Jul 4. doi:10.2147/VHRM.S461308}
2. ^{Cardiovascular Diseases. World Health Organization. June 11, 2021. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)#:~:text=What%20are%20the%20risk%20factors,and%20harmful%20use%20of%20alcohol. Accessed July 11, 2024.}