Psychologic distress has broad vascular risk impact

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By Eleanor McDermid

Psychologic distress has as large an impact on people's cerebrovascular disease risk as on their ischemic heart disease risk, say UK researchers.

The findings corroborate previous research in the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort, which found that psychologic distress, but not major depressive disorder, raised stroke risk.

However, Mark Hamer (University College London) and colleagues note that most previous research has focused on the link between psychologic distress and cardiovascular disease.

This link was also apparent in the current study, which included 68,652 participants of the Health Survey for England (average age 54.9 years, 45% men). The 14.7% of participants who had psychologic distress at baseline (General Health Questionnaire [GHQ]-12 score≥4) had a 1.59-fold increased risk for dying from ischemic heart disease relative to those without psychologic distress (GHQ-12 score=0).

They also had a 1.66-fold increased risk for dying of cerebrovascular disease, over an average follow up lasting 8.1 years, after accounting for confounders including age, gender, ethnicity, socioeconomic group, smoking, and use of antihypertensive medication.

"Although the effect estimates of psychological distress were similar for cerebrovascular and ischemic heart disease, the mechanisms might not necessarily be the same because of the differences in pathogenesis of atherosclerotic lesions in coronary and cerebral arteries," comments the team.

The researchers were not able to determine the effect of psychologic distress on specific types of cerebrovascular disease, as fewer than half of the death certificates used in the analysis provided this information.

"Further work is required to determine whether psychological risk factors have a uniform effect on different subcategories of cerebrovascular disease," Hamer et al write in the Canadian Medical Association journal.

The risk associated with psychologic distress appeared to increase with worsening symptoms, in that GHQ-12 scores of 1-3 had a smaller, but still apparent, effect on the risk for cerebrovascular disease mortality (nonsignificant 1.20-fold increase) and ischemic heart disease (significant 1.26-fold increase), relative to a score of 0.

"Our data suggest that questionnaires such as the GHQ-12 could be of value in systematic screening aimed at improving the recognition of common mental disorders for reducing the risk of cardiovascular disease," say the researchers.

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