Depression and anxiety screens as predictors of 8-year incidence of myocardial infarction and stroke in primary care patients

Objective Because depression and anxiety are typically studied in isolation, our purpose was to examine the relative importance of these overlapping emotional factors in predicting incident cardiovascular disease (CVD). Methods We examined depression and anxiety screens, and their individual items, as predictors of incident hard CVD events, myocardial infarction, and stroke for 8 years in a diverse sample of 2041 older primary care patients initially free of CVD. At baseline, participants completed self-report depression and anxiety screens. Data regarding CVD events were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytic files. Results During follow-up, 683 (33%) experienced a CVD event. Cox proportional hazards models - adjusted for demographic and CVD risk factors - revealed that a positive anxiety screen, but not a positive depression screen, was associated with an increased risk of a hard CVD event in separate models (Years 0-3: Anxiety hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.21-1.96, p <.001; Years 3+: Anxiety HR = 0.99, CI = 0.81-1.21), p =.93; depression HR = 1.10, CI = 0.88-1.36, p =.41), as well as when entered into the same model (Years 0-3: Anxiety HR = 1.53, CI = 1.20-1.95, p <.001; Years 3+: Anxiety HR = 0.99, CI = 0.80-1.21, p =.99; depression HR = 1.03, CI = 0.82-1.29, p =.82). Analyses examining individual items and secondary outcomes showed that the anxiety-CVD association was largely driven by the feeling anxious item and the myocardial infarction outcome. Conclusions Anxiety, especially feeling anxious, is a unique risk factor for CVD events in older adults, independent of conventional risk factors and depression. Anxiety deserves increased attention as a potential factor relevant to CVD risk stratification and a potential target of CVD primary prevention efforts.