Anxiety, Depression and Coronary Spasm: a Synthesis of Epidemiological and Experimental Studies

Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries that causes vessel occlusion through unknown mechanisms, has been demonstrated to be an inflammatory disease, and is an important cause of ischemic heart disease. Epidemiologic data show wide differences in the prevalence of CAS in different countries in that it is higher in Asian than Western countries. For example, the frequency of CAS appears to be greater in the Japanese population than that in Western populations and the diagnosis of variant angina among patients with angina referred to Japanese medical institutions is made in a high percentage, 40%. In addition, the frequencies of multiple spasms (≥2 spastic coronary arteries) by provocative testing in Japanese (24.3%) and Taiwanese populations (19.3%) are markedly higher than those in Caucasians (7.5%). In East Asia as well as Western countries, CAS is more prevalent among men than women. Most patients with CAS are between 40 and 70 years of age, and the prevalence tends to decrease after the age of 70 years. Previous Asian studies of patients without obstructive coronary artery disease have shown that the prevalence of CAS is as high as 57% in patients with acute coronary syndrome. Similar findings were reported in a German study. Smoking, age and high-sensitivity C-reactive protein (hs-CRP) are significant risk factors for CAS. Among psychological factors affecting obstructive coronary artery disease (CAD), anxiety and depression are distinct from other psychological factors in that they have been shown to be risk factors for obstructive CAD and associated with elevated proinflammatory cytokines. Furthermore, anxiety is associated with 60% excess risk of obstructive CAD independent of traditional coronary risk factors. Such an association, however, has never been investigated in patients with CAS. Although several studies reported that patients who had chest pain and normal coronary arteries exhibited more psychiatric illnesses than did patients with CAD, whether the effects of anxiety or depression are unique, or just a general effect of distress are unknown. Accordingly, we have 3 aims. First, we will examine the risk impacts of anxiety and depression among patients with CAS in Taiwan National Health Insurance Research Database by using t-test, logistic regression or other statistical methods. Second, we will conduct a hospital longitudinal cohort study by collecting patients’ blood samples to evaluate biomarkers for early detection of CAS. Furthermore, the mechanisms by which anxiety and depression predispose to CAS will be examined. Third, we will screen and develop effective drugs to treat these patients. Thus, the identification of new biologic factors predictive of individual disease course and prognosis of coronary artery spasm patients would be extremely useful. We used National Health Insurance Research Database combined with clinicopathological data in search of inflammatory biomarkers related to coronary artery spasm response and disease prognosis. From the above-mentioned data, coronary artery spasm indeed is a disease that should be respected it in Taiwan. We hope it can raise a possibility for the the identification of novel molecular markers for disease diagnosis, prognosis, and therapy selection for Coronary artery spasm.