Self-reported anxiety and the risk of clinical events and atherosclerotic progression among patients with Coronary Artery Bypass Grafts (CABG)

Background: Symptoms of anxiety are associated with increased risk of coronary artery disease and potentially poor prognosis among patients with existing coronary artery disease, but whether symptoms of anxiety influence atherosclerotic progression among such patients is uncertain. Accordingly, we evaluated the hypotheses that symptoms of anxiety are associated with adverse clinical outcomes and progression of atherosclerosis among individuals with previous coronary artery bypass graft (CABG) surgery and saphenous vein grafts enrolled in the Post-CABG Trial. Methods: The Post-CABG Trial randomized patients with a history of CABG surgery to either aggressive or moderate lipid lowering and to either warfarin or placebo. Patients were followed up for clinical end points and coronary angiography was conducted at enrollment and after a median follow-up of 4.3 years. Anxiety symptoms were assessed at enrollment using the state portion of the Spielberger State-Trait Anxiety Inventory (STAI) in 1317 patients. Results: In models adjusting for age, sex, race, treatment assignment and years since CABG surgery, a STAI score ≥40 was positively associated with risk of death or myocardial infarction (MI) (OR 1.55, 95% CI 1.01-2.36, P = .044). This association was attenuated slightly when depressive symptoms were included in the model, but lost statistical significance (P = .11). There was a dose-response relationship between STAI score and risk of death or MI. There was no association between self-reported anxiety and atherosclerotic progression of grafts. Conclusions: Anxiety symptoms are associated with increased risk of death or MI among patients with saphenous vein grafts, but this risk does not appear to be mediated by more extensive atherosclerotic progression.