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| |  Patients With Anxiety Have the Best Endothelial Function: Presented at ADAA By Fran Lowry MIAMI, F.L. -- March 27, 2006 -- Patients with anxiety disorders have the best endothelial function compared to patients with mood disorders, comorbid mood and anxiety disorders, or no psychiatric disorder at all, according to a study presented here at the 26th Annual Conference of the Anxiety Disorders Association of America (ADAA). Impaired endothelial function is a known early marker of atherosclerosis and predictor of cardiovascular events, and comorbid anxiety and mood disorders have been linked to increased heart disease, explained Kim L. Lavoie, PhD, Assistant Professor, Montreal Heart Institute (MHI), University of Quebec at Montreal, Montreal, Canada. “But anxiety did not appear to adversely affect the endothelium in our study sample of 45 patients,” she said during her poster presentation on March 25th. “In fact, these patients had the best endothelial activity.” The patients in her study had been referred to the MHI for myocardial perfusion testing with single photon emission computed tomography (SPECT). They underwent a structured, psychiatric interview using the Primary Care Evaluation of Mental Disorders (PRIME-MD) and completed a battery of sociodemographic and medical history questionnaires on the day of their exercise stress test. Based on the PRIME-MD results, patients were classified as having a mood disorder only, anxiety disorder only, a mood and anxiety disorder, or no disorder. Endothelial function was assessed the following day using a nuclear medicine variation of the flow-mediated dilatation technique which calculates the rate of uptake ratio (RUR) between the patient’s hyperaemic and non-hyperaemic arms. After controlling for age and sex, the researchers found a significant main effect of psychiatric group on endothelial function (P <.01). Patients with an anxiety disorder had the best endothelial function as evidenced by the highest RUR (5.41) compared to patients with a mood disorder (RUR = 3.68), mood and anxiety disorder (RUR=2.22) or no disorder (RUR = 3.58). “A normal endothelial score was about 3.2 to 3.5, so if patients had no psychiatric disorder, or if they had a mood disorder only, they were right where they needed to be,” Dr. Lavoie said. “The anxiety disorder patients who had anxiety alone had an even better RUR, which means that they are doing slightly better than average. But if patients had both a mood and an anxiety disorder, our tests showed they had very bad endothelial function, and this means that they are at the greatest cardiac risk.” These results are based on the initial sample of 45 patients. That has now grown to 115 patients, Dr. Lavoie said, and the investigators are examining the additional patients to determine whether the relationship between psychological stress and endothelial function holds. “We also want to determine the extent to which greater endothelial reactivity in anxiety disorder patients reflects endothelial hyperreactivity, relatively superior endothelial function, or some other, unknown mechanism,” she concluded. “We need to research the extent to which greater endothelial reactivity in anxiety disorder patients reflects endothelial hyperactivity,” she added.
[Presentation title: Endothelial Function in Patients Referred for Myocardial Perfusion Imaging: The Impact of Comorbid Anxiety and Mood Disorders. Abstract 290]
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