Patients hospitalized for cardiovascular disease (CVD) had a significantly higher risk of developing psychiatric disorders and attempting suicide, especially within the first year after diagnosis, according to a new study.
In the study, published in the Journal of the American Heart Association, researchers from West China Hospital and Sichuan University conducted a community-based matched cohort study using data from the UK Biobank, which included 63,923 patients first hospitalized with a primary CVD diagnosis between 1997 and 2020 and 127,845 matched unexposed individuals. The study aimed to assess the short- and long-term risks of developing psychiatric disorders and attempting suicide following CVD diagnosis and to examine the effects of genetic susceptibility on these associations.
The researchers found that within the first year of follow-up, the incidence rate of any psychiatric disorder or suicide attempt in exposed patients was nearly twice that of the unexposed individuals (7.5 vs 3.6 per 1,000 person-years, hazard ratio [HR] = 1.83, 95% confidence interval [CI] = 1.58–2.12). The risk remained elevated beyond the first year, with an HR of 1.24 (95% CI = 1.16–1.32). Specific psychiatric disorders such as anxiety, depression, stress-related disorders, and suicide behaviors were also significantly more likely to occur in the patients with CVD.
When analyzing different categories of CVD, the researchers found that the patients with ischemic heart disease, cerebrovascular disease, and arrhythmia/conduction disorder had a significantly increased risk of any psychiatric disorder or suicide attempt within and beyond the first year of follow-up. Those with cerebrovascular disease had the highest risk elevation (≤ 1 year: HR = 3.65, 95% CI = 2.38–5.61; > 1 year: HR = 1.49, 95% CI = 1.24–1.80).
The researchers also investigated the affect of genetic susceptibility on the associations between CVD and the subsequent risk of psychiatric disorders and suicide attempts. They uncovered that the risk of developing specific psychiatric disorders or attempting suicide following CVD did not significantly differ based on an individual's genetic susceptibility to the corresponding psychiatric conditions.
The study controlled for a wide range of factors—including demographic, socioeconomic, environmental, and lifestyle factors—as well as somatic comorbidities. Sensitivity analyses using diagnoses of acute cardiovascular events and competing risk models demonstrated the robustness of the findings.
The median follow-up durations in the exposed and unexposed cohorts were 7.6 and 7.3 years, respectively. Compared with the unexposed individuals, exposed patients had a higher Townsend deprivation index, body mass index, proportion of smoking status, and family history of psychiatric disorders, but lower educational attainment levels and annual household income.
The risk of any psychiatric disorder or suicide attempt within 1 year of follow-up in patients with acute CVD was higher (HR = 2.74, 95% CI = 2.05–3.67) compared with the main analyses (HR = 1.83, 95% CI = 1.58–2.12). During the whole follow-up period, similar positive associations were observed across age at index date and sex. Stronger positive associations were observed among individuals without a history of somatic diseases (Charlson comorbidity index, 0), either within or after the first year of follow-up.
The study used polygenic risk scores to represent the different genetic contributions of a genotype to the corresponding psychiatric condition. The association between polygenic risk scores and the corresponding phenotype was validated using a logistic regression model with adjustment for birth year, sex, genotyping array, and the first 10 principal components for population heterogeneity.
The study had some limitations, including the possibility of delayed timing for the diagnosis of nonacute cardiovascular events, the inclusion of CVD diagnoses only from hospital inpatient admission data, and the measurement of many important confounders only at the baseline stage. The study was conducted using a predominantly European population, and the findings may not be directly generalizable to all populations with CVD.
Based on their findings, the researchers suggested that timely assessment and psychological interventions may be necessary for patients with CVD, regardless of their genetic susceptibility to psychiatric disorders. They also discussed the potential role of cardiologists in the psychiatric-psychological care of these patients, proposing a focus on achieving a healthier lifestyle and better quality of life in addition to treating the cardiovascular condition itself.
The authors declared having no competing interests.
