ABC | Volume 111, Nº5, November 2018

Original Article Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction Pranas Serpytis, 1,2,3 Petras Navickas, 1 Laura Lukaviciute, 1 Alvydas Navickas, 1 Ramunas Aranauskas, 1 Rokas Serpytis, 1,2 Ausra Deksnyte, 1 Sigita Glaveckaite, 1,2 Zaneta Petrulioniene, 1,2 Robertas Samalavicius 1,2 Vilnius University - Faculty of Medicine, 1 Vilnius - Lithuania Vilnius University Hospital Santaros Clinics, 2 Vilnius - Lithuania Clinic of Emergency Medicine - Vilnius University, 3 Vilnius - Lithuania Mailing Address: Pranas Serpytis • Vilnius University Hospital Santaros Clinics, Santariskiu st. 2, 08661, Vilnius – Lithuania E-mail: pranas.serpytis@santa.lt Manuscript received February 14, 2018, revised manuscript May 20, 2018, accepted May 23, 2018 DOI: 10.5935/abc.20180161 Abstract Background: Among patients with heart disease, depression and anxiety disorders are highly prevalent and persistent. Bothdepressionandanxiety play a significant role in cardiovascular diseaseprogressionandare acknowledged tobe independent risk factors. However, there is very little gender-related analysis concerning cardiovascular diseases and emotional disorders. Objective: We aimed to evaluate depression and anxiety levels in patients suffering from myocardial infarction [MI] within the first month after the MI and to assess the association between cardiovascular disease risk factors, demographic indicators and emotional disorders, as well as to determine whether there are gender-based differences or similarities. Methods: This survey included demographic questions, clinical characteristics, questions about cardiovascular disease risk factors and the use of the Hospital Anxiety and Depression Scale [HADS]. All statistical tests were two-sided, and p values < 0.05 were considered statistically significant. Results: It was determined that 71.4% of female and 60.4% of male patients had concomitant anxiety and/or depression symptomatology (p = 0.006). Using men as the reference point, women had an elevated risk of having some type of psychiatric disorder (odds ratio, 2.86, p = 0.007). The HADS-D score was notably higher in women (8.66 ± 3.717) than men (6.87 ± 4.531, p = 0.004). It was determined that male patients who developed depression were on average younger than those without depression (p = 0.005). Conclusions: Women demonstrated an elevated risk of having anxiety and/or depression disorder compared to men. Furthermore, depression severity increased with age in men, while anxiety severity decreased. In contrast, depression and anxiety severity was similar for women of all ages after the MI. A higher depression score was associated with diabetes and physical inactivity, whereas a higher anxiety score was associated with smoking in men. Hypercholesterolemia was associated with both higher anxiety and depression scores, and a higher depression score was associated with physical inactivity in women. (Arq Bras Cardiol. 2018; 111(5):676-683) Keywords: Cardiovascular Diseases; Myocardial Infarction; Anxiety, Depression; Risk Factors; Gender Identify. Introduction By 2020, depression is predicted to be the second highest cause of disability and mortality worldwide, surpassed only by ischemic heart disease (WHO). Myocardial infarction [MI] is a severe life-threatening event that is accompanied by an increased risk of depression and anxiety. 1,2 A recent meta‑analysis that explored the effect of the interactions of risk factors on all-cause mortality in patients withMI concluded that women have worse coronary artery disease [CAD] outcomes compared to men, with more women (17%) than men (12%) dying within 3 years of having their first MI. 3 In addition, hospital mortality rates after acute MI have also been shown to be higher in women (16%) than in men (11%). 4 Gender differences are correspondingly evident regarding mental stress-induced MI when assessing laboratory-based proxies, with a higher prevalence being observed in women than in men, 5 even more so in women aged 50 years or younger. 6 A large-scale case‑control study indicated that post-MI depressive symptoms were associated with an increased risk of mortality, whereas anxiety symptoms were not an independent prognostic risk factor for new cardiovascular events or death. 7 In contrast, another study of 5,750 patients with MI demonstrated that patients with anxiety are at a higher risk of both adverse cardiac events and all-cause mortality. 8 The suicide risk is at its highest during the first month following discharge for MI for both patients with no history of psychiatric illness (adjusted rate ratio – 3.25) and for those with a history of psychiatric disorders (adjusted rate ratio – 64.05), with the rate ratios being comparable with those with no history of MI or psychiatric illness. 7 The suicide risk remained higher for at least five years after theMI. 7 Although post-MI depression is a common and burdensome condition, it remains underrecognized and undertreated. 9,10 There are also very few gender-related analyses concerning cardiovascular 676