Early coronary heart disease increases risk of depression and anxiety

Coronary heart disease (CHD) is the leading cause of death worldwide. However, it is only recently that scientists have begun to look at the mental health implications of the diagnosis, particularly when it occurs at a relatively young age. A new study from the UK Biobank followed almost half a million adults for almost 14 years to find out how age at initial CHD diagnosis affected the risk of new-onset depression and anxiety disorders. The study is published in the journal Acta Psychiatrica Scandinavica.

Study design

• Cohort: 438,376 participants (40–69 years) with no psychiatric diagnoses at inclusion.
• CHD events: Of these, 49,620 were diagnosed with myocardial infarction or angina before or during the study.
• Concomitant data collection: All participants regularly reported new medical diagnoses, including depression and generalized anxiety disorder.
• Methods of analysis: Key factors (gender, age, education level, smoking, comorbidities) were taken into account to assess the association and Cox proportional hazards and propensity score matching models were used for precise comparison with equal non-cardiac control groups.

Key Results

1. CHD increases risk of depression and anxiety

   • Over the course of 13.8 years, patients with coronary heart disease were more likely than their peers without cardiac pathologies to experience depressive and anxiety disorders for the first time.

2. Young age means greater risk

   • For every 10-year decrease in age at diagnosis of CHD, the odds of subsequent depression increased by 73% (HR = 1.73; 95% CI: 1.65–1.82; p < 0.001) and anxiety by 66% (HR = 1.66; 95% CI: 1.57–1.74; p < 0.001).

   • That is, a patient who suffered his first episode of coronary heart disease at age 50 turned out to be significantly more vulnerable to mental disorders than one who had a heart attack at age 60.

3. Propensity score matching

   • Even after strict selection of people without coronary heart disease who were comparable in age, gender, and other factors, the sharp increase in risk persisted in all age groups, but was highest in those who developed the disease in middle age.

Possible mechanisms

• Psychological stress of early diagnosis: Perception of life-threatening conditions may be more detrimental to emotional stability in young patients whose CHD is so sudden.
• Functional limitations: Early limitations in physical activity and lifestyle changes can trigger a feeling of loss of control over one's own life.
• General inflammatory load: Chronic vascular inflammation in CAD may itself disrupt neurotransmitter balance, contributing to depressive and anxiety symptoms.

Practical recommendations

1. Regular psychological screening: include questionnaires for depression and anxiety in post-MI programs, especially for patients under 60 years of age.
2. Early psychosocial support: support groups, educational programs and, if necessary, psychotherapy should begin immediately after discharge.
3. An integrated team: coordination between a cardiologist, psychologist and general practitioner will help to promptly identify and correct emerging mental health problems.

The authors emphasize several key points:

1. Younger patients at particular risk
   “As expected, we saw an increase in the overall risk of depression and anxiety in patients with CHD, but it was most pronounced in the group who developed the disease at a younger age,” comments Dr Anna Smith. “This suggests that the psychological burden of early diagnosis is particularly severe.”

2. The need for screening
   “Routine inclusion of questionnaires for depression and anxiety in post-MI protocols will help to identify suffering at a preclinical stage and initiate timely treatment,” notes co-author Professor Michael Johnson.

3. Multidisciplinary approach
   “It is important for cardiologists to go beyond treating the heart: they need to involve psychologists and therapists to provide comprehensive support to patients, especially those who have had coronary heart disease before the age of 60,” adds Dr. Laura Chen.

4. Future research
   “We need to understand the mechanisms: the psychological, biological and social factors that underlie this relationship,” concludes Dr. Olivier Dupont. “This will give us tools for more precise prevention and rehabilitation programs.”

Conclusion: The study highlights that early diagnosis of coronary heart disease is not only a challenge for the heart, but also a significant risk factor for mental health. Incorporating timely interventions to support emotional state into the standard of care for patients with coronary heart disease can significantly improve their long-term prognosis and quality of life.