The Influencing Factors and Traditional Chinese Medicine Syndrome Characteristics of Depression/Anxiety in Patients with Coronary Heart Disease: A Cross-Sectional Study
Authors: Wu Meng , Li Yu-Bo , Yang Yan , Wang Chuan-Chi , Jiang Li-Jie , Tong Xu , Xu Wei-Ming , Chen Nan-Jie , Hu Jing-Qing 
Published: September 2024

Objective:
The objective of the study was to investigate the situation of depression/anxiety in patients with coronary heart disease (CHD) at different stages of the disease and to analyze the influencing factors and the evolution characteristics of traditional Chinese medicine (TCM) syndromes.

Materials and Methods:
From October 2016 to April 2018, a cross-sectional survey was conducted at 48 clinical research centers in 23 provinces, cities, and autonomous regions across China. A total of 11383 cases were collected by outpatient or inpatient cases, including healthy individuals (n = 1754), low-risk individuals (n = 2339), metabolic syndrome (n = 1475), stable CHD (n = 3366), acute coronary syndrome (n = 704), perioperative intervention treatment (n = 753), and heart failure (n = 992). Survey demographic data, lifestyle habits, disease and health status, TCM symptoms and signs, and other information were collected.

Results:
The prevalence rates of depression/anxiety in surveyed patients with CHD were 35.7% and 21.0%, respectively, and were higher than those in patients with metabolic syndrome (18.8% and 10.3%, respectively), low-risk individuals (11.7% and 7.5%), and healthy individuals (9.7% and 5.7%, respectively). The significant risk factors for CHD combined with depression analyzed by the generalized linear mixed model included age (odds ratio [OR] = 0.019), gender (OR = 0.632), hypertension (OR = 0.306), course of CHD (OR = 0.022), stent placement (OR = −0.284), heart function level (OR = −4.151/−3.336/−2.118), and phlegm stasis syndrome score (OR = 0.129). The significant risk factors for CHD combined with anxiety included gender (OR = 0.581), heart function level (OR = −1.856), and phlegm stasis syndrome score (OR = 0.094). Factor analysis was conducted on the symptoms and signs of patients with CHD combined with depression/anxiety, and 16 common factors were obtained with cumulative contribution rates of 62.83% and 66.13%, respectively. Disease syndromes included liver and kidney deficiency syndrome, liver stagnation and discomfort syndrome, Qi deficiency syndrome, liver meridian fire heat syndrome, kidney deficiency syndrome, phlegm dampness syndrome, heart and gallbladder Qi deficiency syndrome, blood stasis syndrome, lung Qi inversion syndrome, Yang deficiency syndrome, and three symptoms named diseases, including chest tightness, chest pain, insomnia, and head discomfort.

Conclusions:
Through cross-sectional design, the data obtained in this study revealed the actual situation of CHD patients with anxiety or depression at different stages. The influencing factors of CHD patients with depression or anxiety were analyzed through the collected cross-sectional information and further revealed the syndromic characteristics of CHD patients with depression or anxiety at different stages from the perspective of TCM syndromes. The data obtained provide a practical basis for further understanding the clinical characteristics of bicardiac diseases and for proposing treatment strategies in stages.