Newswise — Women with suspected coronary artery disease (CAD) who report taking antidepressant and anti-anxiety medications have an increased risk of cardiovascular events, including heart attacks and strokes, and death compared to women not taking these medications, according to researchers at the Uniformed Services University of the Health Sciences (USU).

Their paper, "Psychotropic medication use and risk of adverse cardiovascular events in women with suspected coronary artery disease,” reports recent findings from the Women's Ischemia Syndrome Evaluation (WISE) study. The WISE study, sponsored by the National Heart, Lung and Blood Institute of the National Institutes of Health, involves investigators at multiple study sites around the U.S., and was designed to develop methods for improved assessment and understanding of coronary artery disease in women.

According to the paper's first author David S. Krantz, Ph.D., Professor and Chairman, Department of Medical and Clinical Psychology at USU, there are several important implications of this research for women with suspected CAD. However, he also emphasized this was a correlational study and not a clinical trial, so this study's results are not definitive.

“Since depression is an important risk factor for CAD morbidity and mortality, women with suspected CAD may be inadequately treated for depression,” said Dr. Krantz. “Taking these medications may be a marker of residual depression and residual depression in these women may account for increased CAD events. However, it needs to be considered that taking antidepressant and anti-anxiety medications may not be beneficial, and may in fact be harmful for some women.”

Dr. Krantz also said women with suspected CAD often have unexplained chest pain, since traditional diagnostic methods for CAD -- for example, coronary angiography -- may not reveal the presence of disease.

“Many women become distressed by the undiagnosed chest pain and are prescribed these medications for this distress,” said Dr. Krantz. Prior findings from the WISE study indicate women with persistent unexplained chest pain have diminished quality of life.

Because the WISE study is not a clinical trial, researchers need to be very cautious about concluding that antidepressant and anti-anxiety medications themselves are responsible for the results of the WISE study, since many factors could be associated with patients using these medications. For this reason, Krantz said, further research needs to examine whether factors such as underlying depression and anxiety, and not medications per se, may be responsible for these results. These findings also emphasize the importance of emotional and psychosocial factors in women with suspected coronary artery disease.

The paper was published in the August 6, 2009, journal, Heart.

Located on the grounds of Bethesda’s National Naval Medical Center and across from the National Institutes of Health, USU is the nation’s federal school of medicine and graduate school of nursing. The University educates health care professionals dedicated to career service in the Department of Defense and the U.S. Public Health Service. Medical students are active-duty uniformed officers in the Army, Navy, Air Force and Public Health Service who are being educated to deal with wartime casualties, natural disasters, emerging infectious diseases, and other public health emergencies. Of the University’s nearly 4,400 physician alumni and more than 400 advanced practice nurses, the vast majority serve on active duty and are supporting operations in Iraq, Afghanistan, and elsewhere, offering their leadership and expertise. The University also has graduate programs open to civilian and military applicants in biomedical sciences and public health committed to excellence in the didactic and research training which have awarded more than 300 Ph.D. and 100 M.S. degrees to date.

For more information about USU and its programs, visit

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Heart (August 6, 2009)