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Psychiatry and Cardiovascular Disease

Correspondence: Send reprint requests to Dr. Muskin, Consultation-Liaison Psychiatry, New York–Presbyterian Hospital–Columbia University Medical Center, 622 West 168th Street, Box 427, New York, NY 10032.

Cardiovascular disease (CVD) affects one in five Americans and is the leading cause of death in the United States, claiming more lives than the next five leading causes of death combined. Psychiatric disorders are also quite common: anxiety disorders affect 20 million people annually, and depression affects 17 million people. CVD and psychiatric illness often coexist. Anxiety and depression are more prevalent in patients with CVD than in the general population. Depression has long been linked to poor medical compliance, to other risk factors for CVD such as smoking and obesity, and to greater functional impairment. Depression also independently predicts the development of CVD in the general population, as well as future cardiac events and mortality in patients with CVD. Anxiety or anxiety disorders independently predict sudden cardiac death in the general population as well as future cardiac events in patients with CVD. The treatment of psychiatric disorders in patients with CVD can be challenging because of the cardiovascular side effects of many psychotropic medications as well as the potential of multiple drug-drug interactions. Moreover, many medications for CVD have psychiatric side effects. This review covers a wide variety of issues related to CVD and psychiatry and provides a guide for psychiatrists treating patients with comorbid CVD and psychiatric symptoms.

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