Background Increased prevalence of mood symptoms during menopause - - PDF document

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Increased Anxiety and Depressive Symptoms Are Associated with Abnormal Resting Cardiac Autonomic Function in Peri- and Postmenopausal Women with Hot Flashes

10/4/2018

Polly Fu, MD

Department of Medicine University of California, San Francisco

Anxiety, Depression, and Autonomic Function 2

Background

• Increased prevalence of mood symptoms during menopause
• Anxiety and depression associated with alterations in cardiac

autonomic function in non-menopausal population

• Cardiac autonomic function alterations associated with

adverse cardiovascular outcome and chronic diseases (diabetes, hypertension)

Anxiety, Depression, and Autonomic Function 3

Background and Aim

• Increased risk for accumulation of cardiovascular risk factors

during menopause with hot flashes linked to subclinical cardiovascular disease

• To examine whether anxiety and depressive symptoms are

associated with an adverse cardiac autonomic profile among midlife women with hot flashes

Anxiety, Depression, and Autonomic Function 4

Methods

Menopausal Treatment Using Relaxation Exercise (MaTURE) Trial

• Parellel-group, single-blinded, randomized trial of slow-paced

respiration for treatment of hot flashes

• Peri- and postmenopausal women, age 40-59 years old, with

at least four hot flashes reported per day

• Recruited from San Francisco Bay Area from Jan 2012 to

Dec 2014

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Anxiety, Depression, and Autonomic Function 5

Methods

Menopausal Treatment Using Relaxation Exercise (MaTURE) Trial

• Anxiety and depressive symptoms assessed as continuous

scores

• Spielberger State Trait Anxiety Inventory
• Hospital Anxiety and Depression Scale
• Beck Depression Inventory-II

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Methods

Menopausal Treatment Using Relaxation Exercise (MaTURE) Trial

• Resting cardiac autonomic function assessed via impedence

cardiography and ECG

• Respiratory sinus arrhythmia (RSA): Parasympathetic activity
• Pre-ejection period (PEP): Sympathetic activity

Anxiety, Depression, and Autonomic Function 7

Methods

Menopausal Treatment Using Relaxation Exercise (MaTURE) Trial

• To determine associations between anxiety, depression, and

cardiac autonomic markers

• Multivariable repeated measures linear regression models
• Adjusted for age and body mass index
• Corrected for multiple comparisons with Benjamini-Hochberg

procedure

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Results

• Among 121 participants (mean age 53 years old)
• Mean of 8 hot flashes per day
• No significant differences in anxiety and depressive symptoms

between paced respiration and music control groups

• Resting cardiac autonomic markers were similar at baseline and

at 12 weeks with no significant between-group differences

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Anxiety, Depression, and Autonomic Function 9

Results

Anxiety, Depression, and RSA (Marker of Parasympathetic Activity) Respiratory Sinus Arrhythmia β (SE) P-value STAI – State Anxiety

• 0.16 (0.01)

0.06 STAI – Trait Anxiety

• 0.03 (0.01)

0.006 HADS Anxiety

• 0.06 (0.02)

0.02 Beck Depression Inventory

• 0.03 (0.01)

0.04 HADS Depression

• 0.07 (0.03)

0.03

STAI – Spielberger State Trait Anxiety Inventory; HADS – Hospital Anxiety and Depression Scale

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Results

Anxiety, Depression, and PEP (Marker of Sympathetic Activity) Pre-Ejection Period β (SE) P-value STAI – State Anxiety

• 0.24 (0.09)

0.02 STAI – Trait Anxiety

• 0.11 (0.10)

0.24 HADS Anxiety

• 0.31 (0.27)

0.25 Beck Depression Inventory

• 0.09 (0.17)

0.60 HADS Depression

• 0.40 (0.36)

0.26

STAI – Spielberger State Trait Anxiety Inventory; HADS – Hospital Anxiety and Depression Scale

Anxiety, Depression, and Autonomic Function 11

Summary

Among peri- and postmenopausal women with hot flashes,

• Greater self-reported anxiety and depression were associated

with lower cardiac vagal tone

• Greater self-reported state anxiety was associated with

higher resting sympathetic nervous system activation

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Summary

• Our findings are consistent with prior studies showing lower

resting parasympathetic activity in patients with clinical anxiety disorders and major depressive disorder

• From cardiovascular risk standpoint, lower RSA associated

with hypertension, hyperglycemia, and obesity. Lower RSA was also a strong predictor of sudden cardiac death after myocardial infarction

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Anxiety, Depression, and Autonomic Function 13

Conclusions

• Midlife women with increased anxiety and depressive

symptoms may have an unfavorable cardiac autonomic profile with potential implication for their overall cardiovascular risk

Anxiety, Depression, and Autonomic Function 14

Acknowledgements

• Alison J. Huang, MAS, MPhil
• Caroly J. Gibson, PhD, MPH
• Wendy Berry Mendes, PhD
• Michael Schembri, BS

MaTURE trial was funded by National Center for Complementary and Integrative Health grant #5R01AT005491