Tully Phillip J, Cosh Suzanne M, Baumeister Harald
Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany.
Clinic of Psychiatry and Psychotherapy II, University of Ulm, Gunzburg, Germany.
J Psychosom Res. 2014 Dec;77(6):439-48. doi: 10.1016/j.jpsychores.2014.10.001. Epub 2014 Oct 14.
To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD.
A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible).
Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio=1.94, 95% CI 1.45-2.60, P<.001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28-64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies.
The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.
（1）报告焦虑症亚型与主要不良心脏事件（MACE）之间的预后关联；（2）报告冠心病（CHD）中焦虑症的患病率；（3）报告焦虑症治疗对冠心病的疗效。
2013年11月进行了全面的电子数据库检索，以查找根据结构化访谈报告冠心病样本中焦虑症患病率或MACE的研究，以及比较焦虑症治疗与安慰剂或常规护理的随机对照试验（RCT）。从4041篇文章中选择了42个样本进行提取（8个用于MACE预后，39个用于患病率，没有符合条件的RCT）。
五项广泛性焦虑症（GAD）研究报告了883例MACE事件（合并n = 2851）。GAD与MACE之间存在非显著关联（风险比= 1.20，95％CI 0.86 - 1.68，P = 0.28），但在门诊样本中效应量非常显著（调整后的风险比= 1.94，95％CI 1.45 - 2.60，P <0.001）。没有其他焦虑症亚型与MACE相关。患病率数据显示与抑郁症的共病率很高（49.06％；95％CI 34.28 - 64.01），且研究之间存在很大异质性。在精神科医生/心理学家评估者中惊恐障碍的患病率更高（9.92％对4.74％），广泛性焦虑症也是如此（18.45％对13.01％）。根据DSM-III-R与DSM-IV分类法，惊恐障碍和广泛性焦虑症的估计值也存在异质性。
现有焦虑症RCT的匮乏，以及门诊广泛性焦虑症患者的MACE风险，应促使对冠心病患者进行进一步的焦虑症干预。研究应侧重于抑郁症和焦虑症，从而揭示特定疾病和更普遍的途径。
