Two new studies show that problems with the mind can play a significant role in problems of the heart.
One study found that anxiety and depression can increase the incidence of angina, the chest pain that sends many people to the doctor, said Dr. Mark Sullivan, professor of psychiatry and behavioral sciences at the University of Washington, and senior author of one of the reports in the June 29 online issue of Circulation.
"The overwhelming focus in the United States has been on ischemia," the blockage of heart arteries, Sullivan said. "That is pretty unique in the world. The rest of the world takes a much more multi-modal approach to chest pain. Ischemia is not the only or most important cause of what patients are feeling."
Stress tests and similar measures are properly used to assess ischemia in people with angina, Sullivan said. "But in addition to the kind of diagnostic studies done with stress tests, patients who have a lot of angina should be screened for anxiety and depression, because they could be very cost-effective targets for intervention," he said.
To prove that point, Sullivan and his colleagues studied 191 people with known ischemia who underwent stress testing and heart imaging. They found that 36 percent reported no angina in the previous month, with 35 percent reporting monthly incidents.
Of the 30 percent who had daily or weekly angina, psychological assessments, including a self-reporting anxiety and depression questionnaire, showed that 44 percent had significant anxiety and two-thirds had significant depression.
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