Coronary Artery Spasm as Related to Anxiety and Depression: A Nationwide Population-Based Study

• Published in: Psychosomatic medicine 2019-04, Vol.81 (3), p.237-245
• Main Authors: Hung, Ming-Yow, Mao, Chun-Tai, Hung, Ming-Jui, Wang, Jiunn-Kae, Lee, Hsin-Chien, Yeh, Chi-Tai, Hu, Patrick, Chen, Tien-Hsing, Chang, Nen-Chung
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anxiety; Anxiety Disorders - epidemiology; Cardiovascular disease; Case-Control Studies; Comorbidity; Confidence intervals; Coronary artery; Coronary artery disease; Coronary Artery Disease - epidemiology; Coronary vessels; Databases, Factual; Depressive Disorder - epidemiology; Female; Heart diseases; Humans; Male; Mental depression; Middle Aged; National health insurance; Population; Population studies; Population-based studies; Propensity; Propensity Score; Retrospective Studies; Risk; Risk factors; Sex differences; Spasm - epidemiology; Stratification; Taiwan - epidemiology
• ISSN: 0033-3174; 1534-7796
• DOI: 10.1097/psy.0000000000000666

Anxiety and depression are risk factors for obstructive coronary artery disease (CAD), but their effects on coronary artery spasm (CAS) remain unestablished. 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. 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. 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.