Abstract 365: Psychiatric Illness is Correlated With Lower Incidence of Obstructive Coronary Artery Disease But Not Mortality in U.S. Veterans

Background: The association between psychiatric illness, coronary artery disease (CAD) and mortality is poorly understood. It has been theorized that psychiatric diseases may result in increased mortality and poor cardiovascular outcomes, but prior studies have been limited by short follow-up time and non-angiographic methods to document CAD. In a long-term follow-up study we report the relationship between psychiatric disease, mortality, and angiographically proven CAD.

Methods: We retrospectively reviewed 1532 consecutive patients presenting to the Dayton VA Medical Center between 2001-2005 for left heart catheterization. “Psychiatric illness” was defined as the prior diagnosis of a psychiatric disorder or the current prescription of antidepressant/antipsychotic medication. We evaluated the association between psychiatric illness, mortality and CAD with mean follow-up time of 9.3 ± 5.4 years.

Results: Of 1532 patients, 503 (32.8%) had a psychiatric illness. Mortality did not differ in patients with and without psychiatric disease (psychiatric disease = 65.4% vs no psychiatric disease = 69.8%, p=0.084). Psychiatric illness had a Cox hazard ratio of 0.92 (CI 0.81-1.05, p=0.20) and 0.97 (CI 0.85-1.11, p=0.63) after controlling for reduced ejection fraction, obstructive coronary artery disease, chronic kidney disease, hypertension, hyperlipidemia, and diabetes mellitus. Patients with psychiatric illness had a lower prevalence of obstructive coronary artery disease compared to those without psychiatric illness (66.6% vs 75.1% respectively, p<0.001).

Conclusion: In a high-risk US Veteran population followed for a mean of 9.3 years, psychiatric disease was associated with a lower incidence of obstructive coronary artery disease but was not associated with a significant difference in mortality. These finding challenge the existing assumption that all psychiatric illnesses are associated with CAD and mortality. The Veteran population (regardless of psychiatric disease) has a high baseline risk factor burden compared to the general population, which may obscure the negative effects of psychiatric disease. Our population had 32.8% mental disease (vs 18.9% in general population per NIMH/NIH), 72.3% obstructive CAD (vs 4.8% per AHA) and mean lifespan of 71.8 years (vs 78.6 years per CDC). Psychiatric illness was associated with lower rates of obstructive CAD and no significant difference in mortality in our population, suggesting that further research is required on individual psychiatric disorders and that Veterans require aggressive management of coronary risk factors.