Association of Depression and Anxiety with Cardiovascular Co-Morbidity and 10-Year Risk of Cardiovascular Mortality (SCORE) in a Primary Care Population of Latvia. Summary of the Doctoral Thesis

Abstract

Background: Depression and cardiovascular (CV) diseases (CVD) are the two most common non-communicable diseases causing disability and mortality worldwide. In Latvia, the mortality rate from CVD is among the highest in the European Union (EU). Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of CVD. The role of these CV risk factors have been underrecognized in Latvia. The largest national epidemiological surveys which were previously carried out to assess cardiovascular risk factors prevalence in Latvian adults have not included depression and anxiety as risk factors. The aim of this study was to examine the association of depression and anxiety with CV comorbidity and the 10-year CV mortality risk in a primary care population of Latvia. Material and methods: This cross-sectional study was carried out within the framework of the National Research Program BIOMEDICINE to assess the prevalence of mental disorders at 24 primary care facilities. During one week period in 2015 all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by socio-demographic questionnaire and measurements of height, weight, waist circumference, blood pressure, total cholesterol. The diagnostic Mini International Neuropsychiatric Interview (MINI) was conducted over the telephone within 2 weeks after the visit to general practitioner. Diagnoses of CVD were confirmed using medical records. The measurement of CV mortality risk was based on the SCORE (The Systematic Coronary Risk Evaluation) system for high risk countries which estimates the 10-year risk of a fatal atherosclerotic CV event. An univariate and multivariate logistic regression analyses were conducted using the conceptual hierarchical framework model. Results: From 1756 approached subjects 152 declined to participate in this study. The mean response rate was 91.3%, it varied between 86.3–93.7% across 24 primary care facilities all over the country. Those who declined did not significantly differ in the basic sociodemographic characteristics from the study sample. In total, 1604 patients were approached to complete the PHQ-9 and the GAD-7 questionnaires, which were completed by 1585 of participants. In the final analysis 1565 subjects were included, 489 (31.2%) men and 1076 (68.8%) women. CVD was detected in 17.1% (n = 268) and a very high 10-year CV mortality risk according to the SCORE ≥10% was detected in 23.4% (n = 367) of study population. Depression screening was positive (PHQ-9 ≥ 10) for 14.7% (n = 228), and anxiety screening was positive (GAD-7 ≥ 10) for 10.1% (n = 156) of the study subjects. According to the MINI, 10.3% (n = 149) had current and 28.1% (n = 407) had lifetime depressive episode, and 16.1% (n = 233) had an anxiety disorder. After adjustment for socio-demographic, lifestyle and traditional CV risk factors, depression was statistically significantly related to CVDs with an odds ratio (OR) of 1.52 (p = 0.04) for current depressive symptoms (PHQ-9 ≥ 10) and 2.08 (p = 0.002) for lifetime depressive episode (MINI). None of the anxiety measures (MINI and GAD-7) showed statistically significant associations with CVD in either the univariate or the multivariate analyses. After adjustment for socio-demographic, lifestyle and traditional CV risk factors depression and anxiety was statistically significantly related to a very high CV mortality risk (SCORE ≥ 10%). Depressive symptoms (PHQ-9 ≥ 10) were associated with a 1.57 (p = 0.03) times higher odds of a very high CV mortality risk, but current anxiety disorder (MINI) reduced the CV mortality risk with an odds ratio of 0.58 (p = 0.02). The strongest association with the SCORE indicator was found for individuals living in the urban capital of Latvia with an OR of 4.00 (p < 0.001) compared to those living in rural areas. Conclusions: This study found a statistically significant relationship of depression and anxiety with CV comorbidity and the 10-year CV mortality risk in a primary care population of Latvia. Current depressive symptoms (PHQ-9 ≥ 10) and a lifetime depressive episode (according to the MINI) were significantly associated with increased risk of CV morbidity with an OR of 2.08 and 1.52, respectively. Depressive symptoms (PHQ-9 ≥ 10) were associated with a 1.57 times higher odds of a very high CV mortality risk, but current anxiety disorder (MINI) reduced the CV mortality risk with an odds ratio of 0.58. Our findings suggest that individuals with CVD and SCORE ≥ 10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD, especially in women. Anxiety could possibly have a protective influence on CV prognosis. Place of residence has been established as an important factor associated with CVD and SCORE ≥ 10%.