Tilburg University, Tilburg, The Netherlands.
Eur J Prev Cardiol. 2013 Feb;20(1):127-34. doi: 10.1177/2047487312436452. Epub 2012 Jan 16.
Negative mood states (e.g., anxiety and depression) have been associated with increased cardiovascular morbidity and mortality in coronary artery disease (CAD), but little is known about the impact of positive emotions on these health outcomes. We examined whether anhedonia (i.e., reduced positive affect) was associated with 7-year mortality in patients treated with percutaneous coronary intervention (PCI).
Consecutive PCI patients (n = 1206; 71.5% men; mean age 62.0 ± 11.1 years) from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at baseline. Anhedonia was defined as a score ≤ 7 (i.e., one SD below the mean) on the positive affect scale of the HADS. The endpoint was defined as all-cause mortality.
The prevalence of anhedonia was 23.7% (286/1206). After a median follow up of 7.0 ± 1.6 years, 186 deaths (15.4%) from any cause were recorded. The incidence of mortality in anhedonic patients was 22.7% (65/286) vs. 13.2% (121/920) in non-anhedonic patients (HR = 1.66, 95% CI [1.19-2.32], p = 0.003). Cumulative hazard functions were significantly different for anhedonic vs. non-anhedonic patients (log-rank χ(2) = 16.61, p < 0.001). In multivariable analysis, anhedonia remained independently associated with all-cause mortality (HR = 1.51, 95% CI [1.03-2.22], p = 0.036), after adjusting for socio-demographics, clinical characteristics, and negative and relaxed affect.
Anhedonia was independently associated with a 1.5-fold increased risk for all-cause mortality in patients who survived the first 6 months post-PCI. Enhancing positive emotions, in addition to reducing negative emotions, may constitute an important target for future psychological intervention trials in CAD patients.
负面情绪状态（如焦虑和抑郁）与冠心病（CAD）的心血管发病率和死亡率增加有关，但人们对积极情绪对这些健康结果的影响知之甚少。我们研究了快感缺失（即积极情绪减少）是否与接受经皮冠状动脉介入治疗（PCI）的患者 7 年死亡率相关。
连续入组来自鹿特丹心脏病学医院雷帕霉素洗脱支架评估研究（RESEARCH）登记处的 1206 例（71.5%为男性；平均年龄 62.0±11.1 岁）接受 PCI 的患者，在基线时使用医院焦虑和抑郁量表（HADS）评估快感缺失。快感缺失的定义为 HADS 积极影响量表得分≤7（即低于平均值一个标准差）。终点定义为全因死亡率。
快感缺失的患病率为 23.7%（286/1206）。中位随访 7.0±1.6 年后，记录到任何原因导致的 186 例死亡（15.4%）。快感缺失患者的死亡率发生率为 22.7%（286/126），而非快感缺失患者为 13.2%（121/920）（HR=1.66，95%CI[1.19-2.32]，p=0.003）。快感缺失患者和非快感缺失患者的累积危险函数差异具有统计学意义（对数秩 χ(2)检验=16.61，p<0.001）。多变量分析显示，在校正社会人口统计学、临床特征以及消极和放松情绪后，快感缺失与全因死亡率独立相关（HR=1.51，95%CI[1.03-2.22]，p=0.036）。
在接受 PCI 后 6 个月存活下来的患者中，快感缺失与全因死亡率增加 1.5 倍独立相关。除了减少负面情绪外，增强积极情绪可能是 CAD 患者未来心理干预试验的一个重要目标。
