Anxiety and Depression Associated With Increased Cardiovascular Disease Risk Through Accelerated Development of Risk Factors

Giovanni Civieri, MD; Shady Abohashem, MD; Simran S. Grewal, DO; Wesam Aldosoky, MD; Iqra Qamar, MD; Erin Hanlon, BS; Karmel W. Choi, PhD; Lisa M. Shin, PhD; Rachel P. Rosovsky, MD, MPH; Sandeep Chandra Bollepalli, PhD; Hui Chong Lau; Antonis Armoundas, PhD; Antonia V. Seligowski, PhD; Sarah M. Turgeon, PhD; Roger K. Pitman, MD; Francesco Tona, MD, PhD; Jason H. Wasfy, MD, MPhil; Jordan W. Smoller, MD, ScD; Sabino Iliceto, MD; Jill Goldstein, PhD, MPH; Catherine Gebhard, MD, PhD; Michael T. Osborne, MD; Ahmed Tawakol, MD

JACC: Advances (Sep 2024)

Anxiety and Depression Associated With Increased Cardiovascular Disease Risk Through Accelerated Development of Risk Factors

Giovanni Civieri, MD,
Shady Abohashem, MD,
Simran S. Grewal, DO,
Wesam Aldosoky, MD,
Iqra Qamar, MD,
Erin Hanlon, BS,
Karmel W. Choi, PhD,
Lisa M. Shin, PhD,
Rachel P. Rosovsky, MD, MPH,
Sandeep Chandra Bollepalli, PhD,
Hui Chong Lau,
Antonis Armoundas, PhD,
Antonia V. Seligowski, PhD,
Sarah M. Turgeon, PhD,
Roger K. Pitman, MD,
Francesco Tona, MD, PhD,
Jason H. Wasfy, MD, MPhil,
Jordan W. Smoller, MD, ScD,
Sabino Iliceto, MD,
Jill Goldstein, PhD, MPH,
Catherine Gebhard, MD, PhD,
Michael T. Osborne, MD,
Ahmed Tawakol, MD

Affiliations

Giovanni Civieri, MD: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
Shady Abohashem, MD: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Simran S. Grewal, DO: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Wesam Aldosoky, MD: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Iqra Qamar, MD: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Erin Hanlon, BS: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Karmel W. Choi, PhD: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
Lisa M. Shin, PhD: Department of Psychology, Tufts University, Medford, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
Rachel P. Rosovsky, MD, MPH: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Sandeep Chandra Bollepalli, PhD: Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
Hui Chong Lau: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Antonis Armoundas, PhD: Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
Antonia V. Seligowski, PhD: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
Sarah M. Turgeon, PhD: Neuroscience Program, Amherst College, Amherst, Massachusetts, USA
Roger K. Pitman, MD: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
Francesco Tona, MD, PhD: Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
Jason H. Wasfy, MD, MPhil: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Jordan W. Smoller, MD, ScD: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Innovation Center on Sex Differences in Medicine (ICON-X), Massachusetts General Hospital, Boston, Massachusetts, USA
Sabino Iliceto, MD: Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
Jill Goldstein, PhD, MPH: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Innovation Center on Sex Differences in Medicine (ICON-X), Massachusetts General Hospital, Boston, Massachusetts, USA
Catherine Gebhard, MD, PhD: Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Inselspital Bern, Bern, Switzerland
Michael T. Osborne, MD: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Ahmed Tawakol, MD: Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Address for correspondence: Dr Ahmed Tawakol, Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, Massachusetts 02114-2750, USA.

Journal volume & issue: Vol. 3, no. 9
p. 101208

Abstract

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Background: Prior studies have incompletely assessed whether the development of cardiometabolic risk factors (CVDRF) (hypertension, hyperlipidemia, and diabetes mellitus) mediates the association between anxiety and depression (anxiety/depression) and cardiovascular disease (CVD). Objectives: The authors aimed to evaluate the following: 1) the association between anxiety/depression and incident CVDRFs and whether this association mediates the increased CVD risk; and 2) whether neuro-immune mechanisms and age and sex effects may be involved. Methods: Using a retrospective cohort design, Mass General Brigham Biobank subjects were followed for 10 years. Presence and timing of anxiety/depression, CVDRFs, and CVD were determined using ICD codes. Stress-related neural activity, chronic inflammation, and autonomic function were measured by the assessment of amygdalar-to-cortical activity ratio, high-sensitivity CRP, and heart rate variability. Multivariable regression and mediation analyses were employed. Results: Among 71,214 subjects (median age 49.6 years; 55.3% female), 27,048 (38.0%) developed CVDRFs during follow-up. Pre-existing anxiety/depression associated with increased risk of incident CVDRF (OR: 1.71 [95% CI: 1.59-1.83], P < 0.001) and with a shorter time to their development (β = −0.486 [95% CI: −0.62 to −0.35], P < 0.001). The development of CVDRFs mediated the association between anxiety/depression and CVD events (log-odds: 0.044 [95% CI: 0.034-0.055], P < 0.05). Neuro-immune pathways contributed to the development of CVDRFs (P < 0.05 each) and significant age and sex effects were noted: younger women experienced the greatest acceleration in the development of CVDRFs after anxiety/depression. Conclusions: Anxiety/depression accelerate the development of CVDRFs. This association appears to be most notable among younger women and may be mediated by stress-related neuro-immune pathways. Evaluations of tailored preventive measures for individuals with anxiety/depression are needed to reduce CVD risk.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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