Yaygın anksiyete bozukluğu olan hastalarda arteriyel sertliğin değerlendirilmesi

Year 2023, Volume: 48 Issue: 2, 385 - 393, 02.07.2023

Burcu Sırlıer Emir , Sevler Yıldız , Aslı Kazğan Kılıçaslan , Kerim Uğur , Osman Kurt

https://doi.org/10.17826/cumj.1219982

Abstract

Amaç: Yaygın anksiyete bozukluğu (YAB) sempatik sistemin aktive olmasıyla birlikte bedensel ve ruhsal belirtilerin bir arada görüldüğü psikiyatrik hastalıktır. Bu hastalıkta kardiyovasküler sistemin etkilendiği bilinmektedir. Bu çalışmada YAB tanılı hastalarda arter sertliğini değerlendirmeyi ve sağlıklı kontrollerle kıyaslamayı amaçladık.
Gereç ve Yöntem: YAB tanısı almış 40 hasta ve 40 sağlıklı birey çalışmaya dahil edildi. Karotis ve femoral arter intima-medial kalınlığı (IMT) ve arteriyel kalınlık parametreleri doppler ultrasonografi ile ölçüldü.
Bulgular: Hastaların femoral IMT değeri anlamlı şekilde düşük bulunmuştur. Hastalarda carotid IMT değeri ise sağlıklılardan daha kalın olmasına rağmen bu fark istatistiksel olarak anlamlı değildi. Fluoksetin eş değer dozu ile femoral IMT arasında negatif yönde anlamlı bir korelasyon belirlenmiştir. Femoral IMT ile fluoksetin eş değer dozu arasında ilişki olduğu görülmüştür.
Sonuç: Arteriyel sertlik YAB' da kardiyovasküler riski gösterebilme potansiyeli açısından araştırılmalıdır. Ateroskleroz belirtilerinin YAB hastalığının doğası gereği mi yoksa kullanılan ilaçlarla ilişkili mi olduğunu netleştirebilmek için daha geniş kapsamlı çalışmalara ihtiyaç bulunmaktadır.

Keywords

Arteriyrl sertlik, yaygın anksiyete bozukluğu, kardiyovasküler risk, intima–media kalınlığı

Evaluation of arterial stiffness in patients with generalized anxiety disorder

Abstract

Purpose: Generalized anxiety disorder (GAD) is a psychiatric condition where both physical and mental symptoms are observed due to the activation of the sympathetic system. It is known that the disorder affects the cardiovascular system. The present study aimed to analyze arterial stiffness in GAD patients and compare the findings with healthy controls.
Materials and Methods: 40 patients diagnosed with GAD and 40 healthy individuals were included in the study. Carotid and femoral artery intima-medial thickness (IMT) and arterial thickness parameters were measured with Doppler ultrasonography.
Results: The femoral IMT of the patients was significantly low. Although the carotid IMT was higher in patients when compared to the controls, the difference was not statistically significant. A significant negative correlation was determined between fluoxetine equivalent dose and femoral IMT. There was a correlation between femoral IMT and fluoxetine equivalent dose.
Conclusion: Arterial stiffness should be investigated for its potential to indicate cardiovascular risk in GAD. Further comprehensive studies should be conducted to clarify whether atherosclerosis symptoms were associated with the nature of the GAD or prescription medicine.

Keywords

Arterial stiffness, generalized anxiety disorder, cardiovascular risk, intima–media thickness.

References

• Kim K, Lee S, Kim JH. Diminished autonomic neuro-cardiac function in patients with generalized anxiety disorder. Neuropsychiatr Dis Treat. 2016;12:3111-18.
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington DC, American Psychiatric Association. 2013.
• Strik JJ, Denollet J, Lousberg R, Honig A. Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol. 2003;42:1801–7.
• Huyut M, Huyut BÇ. Determination of anxiety and depression levels in patients with early-stage coronary artery disease detected with computed tomography coronary angiography. Turk J Cardiovasc Nurs. 2020;11:119–24.
• Bahar A, Sertbaş G, Sönmez A. Diyabetes mellituslu hastaların depresyon ve anksiyete düzeylerinin belirlenmesi. Anadolu Psikiyatri Derg. 2006;7:18-26.
• Smith KJ, Béland M, Clyde M, Gariépy G, Pagé V, Badawi G et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res. 2013;74:89-99.
• Yıldız S, Kazğan A, Kurt O, Tabara MF, Korkmaz S, Önalan E et al. Obezite tanılı bireylerde çocukluk çağı travmaları, bağlanma biçimleri ve savunma mekanizmalarının değerlendirilmesi. Fırat Med J. 2022;27:16-21.
• De Hert M, Detraux J. Vancampfort D. The intriguing relationship between coronary heart disease and mental disorders. Dialogues Clin Neurosci. 2018;20:31-40.
• Takeuchi T, Nakao M, Nomura K, Inoue M, Tsurugano S, Shinozaki Y et al. Association of the metabolic syndrome with depression and anxiety in japanese men: a 1-year cohort study. Diabetes Metab Res Rev. 2009;25:762-67.
• Sunbul M, Zincir SB, Durmus E, Sunbul EA, Cengiz FF, Kıvrak T et al. Anxiety and depression in patients with coronary artery disease. Klinik Psikofarmakol Bulteni. 2013; 23:345-52.
• Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R. Prevalence of anxiety disorders in men and women with established coronary heart disease. J Cardiopulm Rehabil Prev. 2007;27:86-91.
• Rothenbacher D, Hahmann H, Wüsten B, Koenig W, Brenner H. Symptoms of anxiety and depression in patients with stable coronary heart disease: prognostic value and consideration of pathogenetic links. Eur J Cardiovasc Prev Rehabil. 2007;14:547-54.
• Niiranen TJ, Kalesan B, Mitchell GF, Vasan RS. Relative contributions of pulse pressure and arterial stiffness to cardiovascular disease: the framingham heart study. Hypertension. 2019;73:712-17.
• Messas E, Pernot M, Couade M. Arterial wall elasticity: state of the art and future prospects. Diagn Interv Imaging. 2013;94:561-69.
• Fernández-Alvarez V, Linares Sánchez, M, López Alvarez F, Suárez Nieto C, Mäkitie AA, Olsen KD et al. Evaluation of intima-media thickness and arterial stiffness as early ultrasound biomarkers of carotid artery atherosclerosis. Cardiol Ther. 2022;11:231-47.
• Teixeira R, Vieira MJ, Gonçalves A, Cardim N, Gonçalves L. Ultrasonographic vascular mechanics to assess arterial stiffness: a review. Eur Heart J Cardiovasc Imaging. 2016;17:233-46.
• Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M et al. ESC/ESH guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the european society of cardiology and the european society of hypertension. J Hypertens. 2018;36:1953–2041.
• Tourjman V, Kouassi E, Koue ME, Rocchetti M, Fortin-Fournier S, Fusar-Poli P et al. Antipsychotics’ effects on blood levels of cytokines in schizophrenia: a meta-analysis. Schizophr Res. 2013;151:43-47.
• Hayasaka Y, Purgato M, Magni LR, Ogawa Y, Takeshima N, Cipriani A et al. Dose equivalents of antidepressants: evidence-based recommendations from randomized controlled trials. J Affect Disord. 2015;180:179-84.
• Bomhof-Roordink H, Seldenrijk A, van Hout HP, van Marwijk HW, Diamant M, Penninx BW. Associations between life stress and subclinical cardiovascular disease are partly mediated by depressive and anxiety symptoms. J Psychosom Res. 2015;78:332-39.
• Seldenrijk A, van Hout HP, van Marwijk HW, de Groot E, Gort J, Rustemeijer C et al. Carotid atherosclerosis in depression and anxiety: associations for age of depression onset World J Biol Psychiatry. 2011;12:549-58.
• Seldenrijk A, van Hout HP, van Marwijk HW, de Groot E, Gort J, Rustemeijer C et al. Depression, anxiety, and arterial stiffness. Biol Psychiatry. 2011;69:795-803.
• Cicek Y, Durakoglugil ME, Kocaman SA, Guveli H, Cetin M, Erdogan T et al. Increased pulse wave velocity in patients with panic disorder: independent vascular influence of panic disorder on arterial stiffness. J Psychosom Res. 2012;73:145-48.
• Oulis P, Kouzoupis A, Kyrkou K, Masdrakis VG, Georgiopoulos G, Karapoulios E et al. Reversal of increased arterial stiffness in severely depressed women after 6-week antidepressant treatment. J Affect Disord. 2010;122:164-66.
• Hou R, Ye G, Liu Y, Chen X, Pan M, Zhu F et al. Effects of SSRIs on peripheral inflammatory cytokines in patients with generalized anxiety disorder. Brain Behav Immun. 2019;81:105-10.
• Baykara S, Bozdağ PG, Baykara M, Namlı MN. Evaluation of arterial stiffness in patients with schizophrenia. J Clin Neurosci. 2020;79:149-53.
• Pacher P, Kecskemeti V. Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns. Curr Pharm Des. 2004;10:2463–75.
• Yoo S, Kim MY, Cho JY. Syk and src-targeted anti-inflammatory activity of aripiprazole, an atypical antipsychotic. Biochem Pharmacol. 2018;148:1-12.
• Calvi A, Fischetti I, Verzicco I, Belvederi Murri M, Zanetidou S, Volpi R et al. Antidepressant drugs effects on blood pressure. Front Cardiovasc Med. 2021;8:704281.
• Licht CM, de Geus EJ, Seldenrijk A, van Hout HP, Zitman FG, van Dyck R et al. Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension. 2009;53:631–38.
• Yilmaz S, Pekdemir M, Tural U, Uygun M. Comparison of alprazolam versus captopril in high blood pressure: a randomized controlled trial. Blood Press. 2011;20:239–43.
• Tecco J, Monreal J, Staner L. Citalopram may reduce sympathoadrenal hyperactivity in elderly depressed patients: an open multicenter study in belgium and luxembourg. Psychiatr Danub. 2011;23:35–42.
• Hamer M, Batty GD, Marmot MG, Singh-Manoux A, Kivimaki M. Anti-depressant medication use and C-reactive protein: results from two population-based studies. Brain Behav Immun. 2011;25:168–73.
• Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry. 2009;65:732–41.
• Zanoli L, Ozturk K, Cappello M, Inserra G, Geraci G, Tuttolomondo A et al. Inflammation and aortic pulse wave velocity: a multicenter longitudinal study in patients with inflammatory bowel disease. J Am Heart Assoc. 2019;8:e010942.
• Wong ML, Dong C, Esposito K, Thakur S, Liu W, Elashoff RM et al. Elevated stress-hemoconcentration in major depression is normalized by antidepressant treatment: secondary analysis from a randomized, double-blind clinical trial and relevance to cardiovascular disease risk. PLoS One. 2008;3:e2350.
• Wozniak G, Toska A, Saridi M, Mouzas O. Serotonin reuptake inhibitor antidepressants (SSRIs) against atherosclerosis. Med Sci Monit. 2011;17:205-14.
• Camacho Á, McClelland RL, Delaney JA, Allison MA, Psaty BM, Rifkin DE et al. Antidepressant use and subclinical measures of atherosclerosis: the multi-ethnic study of atherosclerosis.J Clin Psychopharmacol. 2016;36:340-6.