Objective: Mood and anxiety disorders are associated with vascular disease though the specificity and magnitude of this association is unclear. We assessed the prevalence of vascular disease and risk factors in a representative sample. We further assessed whether any increased risk of vascular disease occurred independent of available vascular disease risk factors.

Methods: Our sample included Part II respondents of the National Comorbidity Survey Replication (NCS-R), a nationally representative sample of adults 18 years and older (N=5,692). Data was collected by face-to-face household interviews in the 48 contiguous United States between February 2001 and April 2003. Participants with mood disorders were hierarchically classified as having any lifetime history of mania, hypomania, or major depression. Anxiety disorders including panic disorder, generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, social phobia, specific phobia, and separation anxiety disorder were assessed. Individuals without mental disorders served as the reference group. Covariates were measured by self-report and included sex, age, income, smoking, marital status, race/ethnicity, employment, and urbanicity. The primary outcome was vascular disease, including heart disease, heart attack, or stroke. Secondary outcomes assessed prevalence of vascular risk factors: diabetes, high blood pressure, and obesity. Cross-tabulations calculated prevalence and comorbidity. Logistic regression examined the effects of disorders on vascular disease, controlling for covariates. Significance tests were performed using Wald chi-square tests that adjusted for design effects to accommodate sampling weights and to account for stratification and clustering of the multistage sampling. Risk of vascular disease was additionally adjusted for vascular risk factors: diabetes, high blood pressure, and obesity.

Results: In multivariate logistic regression models that adjusted for demographic and clinical correlates (i.e., age, urbanicity, income, smoking, marital status, ethnicity, employment status, obesity, high blood pressure and family history of heart diseases), vascular disease was associated with bipolar disorder in women (OR 2.9, 95% C.I. 1.7-5.0), and major depressive disorder in men (OR 1.8, 95% C.I. 1.1-2.9). Because anxiety disorders were also strongly associated with vascular disease in both men (OR 1.7, C.I., 1.3-2.3), and women (OR 1.5, C.I., 1.1-2.0), we also controlled for anxiety disorders in examining the association between vascular disease and mood disorders. The association between mood disorder and vascular disease was attenuated but remained statistically significant for mania and hypomania, but not for major depressive disorder in women, and the association between major depression and vascular disease became non-significant in men.

Conclusions: The results from this representative sample confirm that vascular disease and risk factors are more common among those with mood and anxiety disorders, particularly for women with bipolar disorder, and men with major depression. Risk factors for vascular disease appear more common in those with mood and anxiety disorders, underscoring the importance of assessing and managing modifiable risk factors for vascular disease. The independence of the associations between mood disorders and vascular disease from the well-established cardiovascular risk factors (diabetes mellitus, family history of heart disease, high blood pressure, smoking, and obesity) suggests the need for future research into this link.