Anxiety and depression and secondary prevention of coronary heart disease in 14 countries across six WHO regions: the INTERASPIRE study - Scorecard - MDSpire

Anxiety and depression and secondary prevention of coronary heart disease in 14 countries across six WHO regions: the INTERASPIRE study

  • By

  • Chantal F Ski

  • Catriona S Jennings

  • Dirk De Bacquer

  • Kornelia Kotseva

  • John William McEvoy

  • Guy De Backer

  • Iris Erlund

  • Sandra Ganly

  • Terhi Vihervaara

  • Gregory Yoke Hong Lip

  • Kausik K Ray

  • Lars Rydén

  • Agnieszka Adamska

  • Ana Abreu

  • Wael Almahmeed

  • Ade Meidian Ambari

  • Junbo Ge

  • Hosam Hasan-Ali

  • Yong Huo

  • Piotr Jankowski

  • Rodney M Jimenez

  • Yong Li

  • Ahmad Syadi Mahmood Zuhdi

  • Abel Makubi

  • Amam Chinyere Mbakwem

  • Lilian Mbau

  • Jose Luis Navarro Estrada

  • Okechukwu Samuel Ogah

  • Elijah Nyainda Ogola

  • Adalberto Quintero-Baiz

  • Mahmoud Umar Sani

  • Maria Ines Sosa Liprandi

  • Jack Wei Chieh Tan

  • Miguel Alberto Urina Triana

  • Tee Joo Yeo

  • David A Wood

  • David R Thompson

  • on behalf of the INTERASPIRE Investigators

  • November 13, 2025

  • 0 min

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Clinical Scorecard: The Relationship Between Anxiety, Depression, and Secondary Prevention of Coronary Heart Disease: Insights from the INTERASPIRE Study Across Six WHO Regions

At a Glance

CategoryDetail
ConditionCoronary Heart Disease (CHD) with comorbid anxiety and depression
Key MechanismsAnxiety and depression contribute to poorer CHD outcomes via lifestyle, behavioral, and biological pathways including poor diet, medication non-adherence, stress-related neural activity, and chronic inflammation
Target PopulationAdults aged 20-80 years hospitalized with incident or recurrent CHD within the preceding 6–24 months
Care SettingSecondary prevention programs across multiple international healthcare settings spanning six WHO regions

Key Highlights

  • Increasing severity of anxiety and depression symptoms is associated with reduced achievement of guideline targets for CHD secondary prevention.
  • Women with CHD have a higher prevalence and severity of anxiety and depression, both individually and as comorbid conditions.
  • Secondary prevention programs should integrate risk-stratified management addressing both mental health and cardiovascular risk factors to improve outcomes.

Guideline-Based Recommendations

Diagnosis

  • Screen for symptoms of anxiety and depression in patients with CHD during secondary prevention assessments.

Management

  • Implement holistic treatment approaches addressing both mental health (anxiety and depression) and cardiovascular risk factors.
  • Incorporate risk-stratified management of anxiety and depression symptoms within CHD secondary prevention programs.

Monitoring & Follow-up

  • Regularly assess achievement of lifestyle, risk factor, and therapeutic targets using standardized tools such as the INTERASPIRE-Guideline Target Score (GTS).
  • Monitor mental health symptom severity to identify patients at risk of suboptimal secondary prevention adherence.

Risks

  • Recognize that anxiety and depression increase the risk of poor adherence to lifestyle and therapeutic recommendations, leading to worse cardiovascular outcomes.
  • Be aware that underestimation of residual cardiovascular risk is common in patients with psychosocial stress, complicating guideline implementation.

Patient & Prescribing Data

Adults with incident or recurrent CHD across 14 countries representing six WHO regions.

Patients with symptoms of anxiety and/or depression are less likely to achieve recommended secondary prevention targets, indicating a need for integrated mental health and cardiovascular care.

Clinical Best Practices

  • Adopt interdisciplinary and holistic care models that address both physical and mental health in CHD patients.
  • Use standardized assessments like the INTERASPIRE-GTS to evaluate secondary prevention target achievement.
  • Prioritize identification and management of anxiety and depression to improve adherence and cardiovascular outcomes.
  • Tailor secondary prevention strategies to consider sex differences, given higher prevalence of anxiety and depression in women with CHD.

References

Original Source(s)

Anxiety and depression and secondary prevention of coronary heart disease in 14 countries across six WHO regions: the INTERASPIRE study

  • by Chantal F Ski, Catriona S Jennings, Dirk De Bacquer, Kornelia Kotseva, John William McEvoy, Guy De Backer, Iris Erlund, Sandra Ganly, Terhi Vihervaara, Gregory Yoke Hong Lip, Kausik K Ray, Lars Rydén, Agnieszka Adamska, Ana Abreu, Wael Almahmeed, Ade Meidian Ambari, Junbo Ge, Hosam Hasan-Ali, Yong Huo, Piotr Jankowski, Rodney M Jimenez, Yong Li, Ahmad Syadi Mahmood Zuhdi, Abel Makubi, Amam Chinyere Mbakwem, Lilian Mbau, Jose Luis Navarro Estrada, Okechukwu Samuel Ogah, Elijah Nyainda Ogola, Adalberto Quintero-Baiz, Mahmoud Umar Sani, Maria Ines Sosa Liprandi, Jack Wei Chieh Tan, Miguel Alberto Urina Triana, Tee Joo Yeo, David A Wood, David R Thompson, on behalf of the INTERASPIRE Investigators

  • November 13, 2025

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