{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:28:48Z","timestamp":1777523328404,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T00:00:00Z","timestamp":1678147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Research Foundation (DFG)","award":["#HE3115\/10-1"],"award-info":[{"award-number":["#HE3115\/10-1"]}]},{"name":"German Research Foundation (DFG)","award":["NCT00705965"],"award-info":[{"award-number":["NCT00705965"]}]},{"name":"PI Christoph Herrmann-Lingen, G\u00f6ttingen, Christian Albus, K\u00f6ln","award":["#HE3115\/10-1"],"award-info":[{"award-number":["#HE3115\/10-1"]}]},{"name":"PI Christoph Herrmann-Lingen, G\u00f6ttingen, Christian Albus, K\u00f6ln","award":["NCT00705965"],"award-info":[{"award-number":["NCT00705965"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Behavioral and physiological risk factors worsen the prognosis of coronary heart disease (CHD). Anxiety is known to be a psychological predictor of CHD. In this study, we investigated whether this factor is associated with all-cause mortality in CHD patients in the long term. Methods: We studied 180 patients (mean age 60.6 SD 9.2 years, 26% women) with CHD from the Berlin Anxiety Trial (BAT) and the Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) study. Their cardiac and psychological risk profile was represented by standardized procedures, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Mortality outcomes were assessed using a community-based registry. Results: Of 180 patients, we obtained information on all-cause mortality in 175 (96.7%) after a mean follow-up of 12.2 years (range 10.4\u201316.6 years). Of all participants, 54.4% had prior myocardial infarction, 95.3% had percutaneous transluminal coronary angioplasty and 22.2% had prior coronary artery bypass graft. Most of the patients (98.4%) had New York Heart Association class I and II, 25.6% had diabetes and 38.2% were smokers. Patients had a mean HADS anxiety score of 9.7 SD 4.1 at study entrance. We found the highest HADS anxiety quartile all-cause mortality in 14%, 30.2% in the middle quartiles and 58.7% in the lowest quartile (chi2 20.8, p = 0.001). Related to psychological mechanisms, a low level of anxiety, seemed to be a significant predictor of all-cause mortality. We found no advantage for patients who had received psychosocial therapy in terms of survival. Conclusion: These first data confirmed our hypothesis about the association of psychological risk factors with the long-term outcome of CAD patients. Future studies will clarify whether the severity of disease, age or a particular type of coping or denial mechanism are associated with the presented outcome in low-anxious patients.<\/jats:p>","DOI":"10.3390\/jcm12062098","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T01:58:22Z","timestamp":1678240702000},"page":"2098","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Does Anxiety Affect Survival in Patients with Coronary Heart Disease?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8575-4570","authenticated-orcid":false,"given":"Hans-Christian","family":"Deter","sequence":"first","affiliation":[{"name":"Medical Clinic, Division of Psychosomatic Medicine, Charit\u00e9 Universit\u00e4tsmedizin, Campus Benjamin Franklin, 12203 Berlin, Germany"},{"name":"German Center for Cardiovascular Research, Partner Site Berlin, 10785 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Albert","sequence":"additional","affiliation":[{"name":"Psychosomatics, Medical Heart Center of Charite and German Heart Institute Berlin, Institute of Cardiothoracic and Vascular Surgery, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cora","family":"Weber","sequence":"additional","affiliation":[{"name":"Medical Clinic, Division of Psychosomatic Medicine, Charit\u00e9 Universit\u00e4tsmedizin, Campus Benjamin Franklin, 12203 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Merswolken","sequence":"additional","affiliation":[{"name":"Medical Clinic, Division of Psychosomatic Medicine, Charit\u00e9 Universit\u00e4tsmedizin, Campus Benjamin Franklin, 12203 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Orth-Gom\u00e9r","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Herrmann-Lingen","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University of G\u00f6ttingen Medical Center, 37075 Gottingen, Germany"},{"name":"German Center for Cardiovascular Research, Partner Site G\u00f6ttingen, 37075 G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna-Sophia","family":"Gr\u00fcn","sequence":"additional","affiliation":[{"name":"Medical Clinic, Division of Psychosomatic Medicine, Charit\u00e9 Universit\u00e4tsmedizin, Campus Benjamin Franklin, 12203 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/S0022-3999(99)00086-0","article-title":"Effects of anxiety and depression on 5-year mortality in 5057 patients referred for exercise testing","volume":"48","author":"Herrmann","year":"2000","journal-title":"J. Psychosom. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0022-3999(99)00101-4","article-title":"Is panic disorder associated with coronary artery disease? A critical review of the literature","volume":"48","author":"Fleet","year":"2000","journal-title":"J. Psychosom. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/01.psy.0000138126.90551.62","article-title":"The High Prevalence of Multiple Psychiatric Disorders in Stable Outpatients With Coronary Heart Disease","volume":"66","author":"Bankier","year":"2004","journal-title":"Psychosom. Med."},{"key":"ref_4","first-page":"571","article-title":"Long-Term Survival Differences Among Low-Anxious, High-Anxious and Repressive Copers Enrolled in the Montreal Heart Attack Readjustment Trial","volume":"64","author":"Gravel","year":"2002","journal-title":"Psychosom. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.jpsychores.2008.08.001","article-title":"Anxiety, independent of depressive symptoms, is associated with in-hospital cardiac complications after acute myocardial infarction","volume":"65","author":"Huffman","year":"2008","journal-title":"J. Psychosom. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1001\/archinte.160.13.1913","article-title":"The influence of anxiety and depression on outcomes of patients with coronary artery disease","volume":"160","author":"Januzzi","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1001\/archgenpsychiatry.2007.4","article-title":"Depression and Anxiety as Predictors of 2-Year Cardiac Events in Patients With Stable Coronary Artery Disease","volume":"65","year":"2008","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/S0002-9149(00)01174-7","article-title":"Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease","volume":"86","author":"Sullivan","year":"2000","journal-title":"Am. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1097\/PSY.0b013e3181dbff97","article-title":"Prognostic Association of Anxiety Post Myocardial Infarction With Mortality and New Cardiac Events: A Meta-Analysis","volume":"72","author":"Roest","year":"2010","journal-title":"Psychosom. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.ypmed.2008.02.016","article-title":"Depression and anxiety associated with cardiovascular disease among persons aged 45 years and older in 38 states of the United States, 2006","volume":"46","author":"Fan","year":"2008","journal-title":"Prev. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.ahj.2010.02.033","article-title":"Anxiety disorders increase risk for incident myocardial infarction in depressed and nondepressed Veterans Administration patients","volume":"159","author":"Scherrer","year":"2010","journal-title":"Am. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1097\/PSY.0b013e31819e6706","article-title":"Generalized Anxiety Disorder, Major Depressive Disorder, and Their Comorbidity as Predictors of All-Cause and Cardiovascular Mortality: The Vietnam Experience Study","volume":"71","author":"Phillips","year":"2009","journal-title":"Psychosom. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1159\/000080387","article-title":"Prospective Examination of Anxiety Persistence and Its Relationship to Cardiac Symptoms and Recurrent Cardiac Events","volume":"73","author":"Grace","year":"2004","journal-title":"Psychother. Psychosom."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.1017\/S0033291715000963","article-title":"Panic disorder and incident coronary heart disease: A systematic review and meta-regression in 1 131 612 persons and 58 111 cardiac events","volume":"45","author":"Tully","year":"2015","journal-title":"Psychol. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1177\/2047487313505244","article-title":"Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting","volume":"22","author":"Meyer","year":"2013","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10364","DOI":"10.1523\/JNEUROSCI.2550-04.2004","article-title":"State Anxiety Modulation of the Amygdala Response to Unattended Threat-Related Stimuli","volume":"24","author":"Bishop","year":"2004","journal-title":"J. Neurosci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s12529-012-9233-6","article-title":"Anxiety as Predictor of the Cortisol Awakening Response in Patients with Coronary Heart Disease","volume":"20","author":"Merswolken","year":"2012","journal-title":"Int. J. Behav. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Weber, C., Fangauf, S.V., Michal, M., Ronel, J., Herrmann-Lingen, C., Ladwig, K.-H., Beutel, M., Albus, C., S\u00f6llner, W., and Perschel, F.H. (2022). Cortisol Awakening Reaction and Anxiety in Depressed Coronary Artery Disease Patients. J. Clin. Med., 11.","DOI":"10.3390\/jcm11020374"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1097\/01.psy.0000228342.53606.b3","article-title":"Phobic Anxiety, Depression, and Risk of Ventricular Arrhythmias in Patients With Coronary Heart Disease","volume":"68","author":"Watkins","year":"2006","journal-title":"Psychosom. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/01.PSY.0000073870.93003.C4","article-title":"High Plasma Levels of N-Terminal Pro-Atrial Natriuretic Peptide Associated With Low Anxiety in Severe Heart Failure","volume":"65","author":"Binder","year":"2003","journal-title":"Psychosom. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"109728","DOI":"10.1016\/j.jpsychores.2019.05.006","article-title":"Longitudinal relationship between B-type natriuretic peptide and anxiety in coronary heart disease patients with depression","volume":"123","author":"Fangauf","year":"2019","journal-title":"J. Psychosom. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0022-3999(99)00024-0","article-title":"Coping with coronary heart disease: A longitudinal study","volume":"47","author":"Maes","year":"1999","journal-title":"J. Psychosom. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.ahj.2015.09.013","article-title":"Association between anxiety and mortality in patients with coronary artery disease: A meta-analysis","volume":"170","author":"Celano","year":"2015","journal-title":"Am. Heart J."},{"key":"ref_24","first-page":"381","article-title":"Symptoms of depression and anxiety in patients with coronary heart disease: Natural course and results of a psychotherapeutic pilot study","volume":"54","author":"Merswolken","year":"2008","journal-title":"Z. Psychosom. Med. Psychother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1159\/000329177","article-title":"Treating Anxiety in Patients with Coronary Heart Disease: A Randomized Controlled Trial","volume":"80","author":"Merswolken","year":"2011","journal-title":"Psychother. Psychosom."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1097\/PSY.0000000000000332","article-title":"A Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD): Results of an Observer-Blinded, Multicenter, Randomized Trial in Depressed Patients With Coronary Artery Disease","volume":"78","author":"Beutel","year":"2016","journal-title":"Psychosom. Med."},{"key":"ref_27","unstructured":"Gr\u00fcn, A.S., and Weber, C. (2023). Social support, gender, and other psychosocial predictors of survival of CHD patients. J. Psychosom. Res., submitted."},{"key":"ref_28","unstructured":"Herrmann, C., Buss, U., and Snaith, R.P. (1995). HADS-D-Hospital Anxiety and Depression Scale-Deutsche Version, Huber."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/01.psy.0000149256.81953.49","article-title":"DS14: Standard Assessment of Negative Affectivity, Social Inhibition, and Type D Personality","volume":"67","author":"Denollet","year":"2005","journal-title":"Psychosom. Med."},{"key":"ref_31","unstructured":"Wittchen, H., Zaudig, M., and Fydrich, T. (1997). Strukturiertes Klinisches Interview f\u00fcr DSMIV (SKID I und SKID-II), Hogrefe."},{"key":"ref_32","unstructured":"Schneider, S., and Margraf, J. (2006). DIPS: Diagnostisches Interview bei Psychischen St\u00f6rungen, Springer."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jacc.2010.03.034","article-title":"Anxiety and Risk of Incident Coronary Heart Disease: A Meta-Analysis","volume":"56","author":"Roest","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/PSY.0b013e3181c64fc0","article-title":"Role of Cardiac Disease Severity in the Predictive Value of Anxiety for All-Cause Mortality","volume":"72","author":"Meyer","year":"2010","journal-title":"Psychosom. Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Blumenthal, J.A., Smith, P.J., Jiang, W., Hinderliter, A., Watkins, L.L., Hoffman, B.M., Kraus, W.E., Mabe, S., Liao, L., and Davidson, J. (2022). Exercise and Escitalopram in the Treatment of Anxiety in Patients with Coronary Heart Disease: One Year Follow-Up of the UNWIND Randomized Clinical Trial. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9100320"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1001\/jamapsychiatry.2021.2236","article-title":"Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients with Coronary Heart Disease: The Understanding the Benefits of Exercise and Escitalopram in Anxious Patients with Coronary Heart Disease (UNWIND) Randomized Clinical Trial","volume":"78","author":"Blumenthal","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Buigues, C., Queralt, A., De Velasco, J., Salvador-Sanz, A., Jennings, C., Wood, D., and Trapero, I. (2021). Psycho-Social Factors in Patients with Cardiovascular Disease Attending a Family-Centred Prevention and Rehabilitation Programme: EUROACTION Model in Spain. Life, 11.","DOI":"10.3390\/life11020089"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1161\/CIRCOUTCOMES.108.812859","article-title":"Stress reduction prolongs life in women with coronary disease. The Stockholm Women\u2019s Intervention Trial for Coronary Heart Disease (SWITCHD)","volume":"2","author":"Schneidermann","year":"2009","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_39","first-page":"1","article-title":"Psychological interventions for coronary heart disease","volume":"4","author":"Rees","year":"2004","journal-title":"Cochrane Libr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s12529-008-9030-4","article-title":"Long-Term Effects of a Multimodal Behavioral Intervention on Myocardial Perfusion\u2014A Randomized Controlled Trial","volume":"16","author":"Albus","year":"2009","journal-title":"Int. J. Behav. Med."},{"key":"ref_41","unstructured":"Herrmann-Lingen, C., and Buss, U. (2002). Angst und Depressivit\u00e4t im Verlauf der Koronaren Herzkrankheit. Reihe Statuskonferenz Psychokardiologie, VAS-Verlag."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1016\/j.jacc.2003.07.007","article-title":"Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction","volume":"42","author":"Strik","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jacc.2007.09.033","article-title":"Anxiety Characteristics Independently and Prospectively Predict Myocardial Infarction in Men: The Unique Contribution of Anxiety Among Psychologic Factors","volume":"51","author":"Shen","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1055\/s-2003-45132","article-title":"Stress Responsive Neurohormones in Depression and Anxiety","volume":"36","author":"Holsboer","year":"2003","journal-title":"Pharmacopsychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jacc.2010.04.013","article-title":"What Does Heart Disease Have to Do With Anxiety?","volume":"56","author":"Dimsdale","year":"2010","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/6\/2098\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:50:03Z","timestamp":1760122203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/6\/2098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,7]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["jcm12062098"],"URL":"https:\/\/doi.org\/10.3390\/jcm12062098","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,7]]}}}