Previous Cardiovascular and Cerebrovascular Events Increase Risk of Depression or Anxiety Disorder in Patients with Chronic Limb-Threatening Ischemia

Posted onAuthorGabriela Elena Strete, Alexandru Andrei Ujlaki Nagi, Andreea Daniela Joenel, Alecu Vicențiu Ciapi, Răzvan Cătălin Son, Zoltán László, Paula Bândea, Alexandru Mureșan

ABSTRACT
Background: Chronic limb-threatening ischemia (CLTI), the most severe type of peripheral arterial disease (PAD), is characterized by rest pain, ischemic ulcers, or gangrene. It is associated with high rates of amputation, hospitalization, and mortality. Depression affects between 16% and 35% of patients with PAD, while anxiety disorders are present in approximately 24.4% to 29%. Aim of the study: This study aims to identify and analyze the risk factors associated with the presence of anxiety or depressive disorders in patients with CLTI. Material and Methods: In this monocentric, retrospective, observational study, all patients with CLTI admitted to the Vascular Surgery Clinic of the Târgu Mureș County Emergency Clinical Hospital from January 2020 to December 2023 were included. Demographic data, comorbidities, risk factors, and laboratory data were collected from the hospital’s electronic database. Additionally, cardiovascular events (history of myocardial infarction or angina pectoris) and cerebrovascular events (including stroke or transient ischemic attack) were documented, along with the presence of depression or anxiety disorders. Results: A total of 113 patients with CLTI were enrolled, with a mean age of 70.54 ± 8.96 years. Of the entire cohort, 14 patients (12.39%) were diagnosed with depression or anxiety disorder. Based on the presence of depression or anxiety disorder, no significant differences were observed concerning demographic data, comorbidities, and risk factors, except for cardiovascular events (35.71% vs. 11.11%; p = 0.013) and cerebrovascular events (64.29% vs. 12.12%; p < 0.001). Regarding laboratory findings, only blood urea nitrogen levels were higher in patients with depression or anxiety disorder (p = 0.023). In the univariate analysis, cardiovascular events (OR 4.44; p = 0.020) and cerebrovascular events (OR 13.05; p < 0.001) were linked to depression or anxiety. Conclusions: A history of cardiovascular and cerebrovascular events was strongly linked to an increased risk of depression or anxiety in patients with CLTI. This emphasizes the close connection between vascular disease and mental health, indicating that neurological and cardiac conditions might worsen psychological distress in this at-risk group.