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Coronary Artery Spasm as Related to Anxiety and Depression

A Nationwide Population-Based Study

Hung, Ming-Yow, PhD; Mao, Chun-Tai, MD; Hung, Ming-Jui, PhD; Wang, Jiunn-Kae, MD; Lee, Hsin-Chien, MD; Yeh, Chi-Tai, PhD; Hu, Patrick, PhD; Chen, Tien-Hsing, MD; Chang, Nen-Chung, PhD

doi: 10.1097/PSY.0000000000000666
ORIGINAL ARTICLE
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Objective Anxiety and depression are risk factors for obstructive coronary artery disease (CAD), but their effects on coronary artery spasm (CAS) remain unestablished.

Methods Patient records in this population-based study were retrospectively collected from the Taiwan National Health Insurance Research Database. Using propensity score matching, we used 1:1:1 ratio stratification into a control group of 10,325 individuals without CAS or CAD, a CAS group comprising 10,473 patients, and a CAD group comprising 10,473 patients during 2000–2012.

Results The prevalence of CAS and CAD was 0.067% and 8.7%, respectively, in the general population. The prevalence of anxiety and depression diagnoses was significantly higher in patients with new-onset CAS than in those with new-onset CAD and controls without CAS/CAD, even after propensity score matching. Compared with CAD, anxiety and depression diagnoses conferred a higher risk of developing CAS (odds ratio [OR] = 2.29, 95% confidence interval [CI], 2.14–2.45, p < .001, and OR = 1.34, 95% CI, 1.08–1.66, p = .007, respectively). The association was even stronger when comparing CAS with the control group without CAD or CAS (OR = 5.20, 95% CI, 4.72–5.74, p < .001, and OR = 1.98, 95% CI, 1.50–2.62, p < .001, respectively). The increased risk of new-onset CAS as related to previous anxiety and depression diagnoses was comparable between males and females.

Conclusions Compared with CAD or the general population, anxiety and depression diagnoses confer a higher risk of developing CAS. No sex differences are found for the association of anxiety and depression with CAS.

From the Division of Cardiology (Hung), Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Internal Medicine (Hung), School of Medicine, College of Medicine, Taipei Medical University, Taipei City; Division of Cardiology (Mao, Hung, Chen), Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan; Department of Psychiatry (Wang, Lee), Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Psychiatry (Wang, Lee), School of Medicine, College of Medicine, Taipei Medical University, Taipei City; Department of Medical Research and Education (Yeh), Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; University of California (Hu), Riverside; Department of Cardiology (Hu), Riverside Medical Clinic, California; and Division of Cardiology (Chang), Department of Internal Medicine, Taipei Medical University Hospital, Taiwan.

Address correspondence to Nen-Chung Chang, PhD, Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi District, Taipei City 110, Taiwan. E-mail: 861003@h.tmu.edu.tw; or Tien-Hsing Chen, MD, Department of Cardiology, Chang Gung Memorial Hospital, Keelung, 222 Maijin Rd, Keelung City 20401, Taiwan. E-mail: skyheart0826@gmail.com

Received for publication November 8, 2017; revision received October 17, 2018.

Copyright © 2019 by American Psychosomatic Society
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