According to a study in the most recent edition of Psychotherapy and Psychosomatics, taking benzodiazepines to manage anxiety may increase survival in patients with congestive heart failure. When it comes to psychiatric comorbidities in CVD patients, depression (in its many manifestations and as various entities) is typically the main focus of research and treatment. As a risk factor and a treatment priority, anxiety and depression are frequently treated as a single entity. Thus, the preferred method for treating depression and anxiety in individuals with CVD has been the use of newer antidepressants with lessened cardiac toxicity and stated efficacy for both conditions.

New insights on the link between Benzodiazepines and Heart Health

In the latest issue of Psychotherapy and Psychosomatics, two compelling articles shed light on the often-neglected relationship between anxiety and cardiovascular disease (CVD), challenging the conventional understanding of its role in patient care. Long et al. conducted a study at the Montreal Heart Institute’s psychosomatic outpatient clinic, focusing on patients referred by cardiologists for symptoms of anxiety or depression. The researchers sought to establish a specific link between CVD and anxiety disorders, exploring potential variations in the distribution of anxiety disorders within CVD patients compared to the general population. Through unstructured interviews following DSM criteria, they discovered that 30% of the 335 CVD patients exhibited symptoms of anxiety disorders. Notably, panic disorder (PD)/agoraphobia accounted for 15%, generalized anxiety disorder (GAD) for 13%, and posttraumatic stress disorder (PTSD) for 3%. Strikingly, the distribution of these disorders in the CVD population significantly differed from that in the general population. Further analysis revealed that having a congenital heart disease was associated with a specific anxiety disorder. These findings underscore the importance of not only addressing depressive symptoms but also recognizing and treating specific anxiety symptomatology in CVD patients.

In another study by Diez-Quevedo et al., the potential risks of using benzodiazepines (BZs) in patients with congestive heart failure (CHF) were investigated, focusing on the impact of BZs on mortality. The study, conducted in a specialized Heart Failure Clinic in Badalona, Spain, from 2001 to 2017, followed 2,139 CHF patients for a median of 7.96 years. Out of these predominantly white male patients, 49.2% received at least a one-month prescription for BZs, including alprazolam, lorazepam, diazepam, and lormetazepam. Surprisingly, the study revealed a 15% reduction in the risk of mortality associated with BZ prescriptions, a significance that persisted even after adjusting for various variables. While the study had its limitations, these findings suggest that BZs could serve as a valuable adjunct treatment for CHF patients, potentially alleviating stress, anxiety, insomnia, and allostatic overload.

Overall, these studies urge healthcare professionals to broaden their perspective on cardiovascular care, recognizing and addressing the intricate interplay between anxiety and heart health. By doing so, we may uncover new avenues for improving the holistic well-being of individuals dealing with cardiovascular challenges.

Rising need to address Anxiety in CVD Patients

  • Beyond depression and stress, anxiety is increasingly being recognized as having an impact on CVD patients. A number of cardiac ailments are characterized by anxiety, which affects the development of illnesses such as coronary artery disease (CAD) and heart failure. Up to 30% of patients experience chronic post-ACS anxiety, which is frequently permanent.
  • Understanding the associations between anxiety and cardiovascular health reveals a complex relationship. While anxiety may serve as a normal response to stress, prolonged or excessive anxiety becomes detrimental. Studies indicate that anxiety, when present for extended periods, is linked to the incidence and progression of cardiovascular diseases.
  • Anxiety has been linked to worse cardiac outcomes in patients with established CAD, including recurrent episodes and mortality. In individuals with heart failure, there is a reduced correlation between anxiety and cardiac outcomes, although anxiety is still a risk factor for poor outcomes.
  • Anxiety disorders, such as post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD), are common in cardiac patients and have an impact on their general health. These conditions have distinctive relationships with cardiac outcomes, highlighting the necessity of specialized diagnosis and care.
  • The behavioral and physiological processes that mediate the links between anxiety disorders and heart health. The complex interactions between anxiety and cardiovascular illnesses are influenced by a variety of factors, including healthy habits, inflammation, endothelial dysfunction, platelet dysfunction, and autonomic dysfunction.

Treatment of Benzodiazepines for Anxiety in CVD Patients

  • Benzodiazepines majorly help with somatic complaints affecting the cardiovascular and gastrointestinal systems in addition to disorders like tension headache and back pain. These somatic complaints include conditions like back pain and gastrointestinal problems. 
  • Benzodiazepines are flexible medications with a wide range of applications. They are not intended to be used as a long-term treatment plan like antidepressant medications, and they don’t have the same negative side effects. Numerous therapy research have shown that benzodiazepines are effective in symptom relief and wellness enhancement in people with CVDs including unstable myocardial ischemia and hypertension. And, epidemiological research suggests that the hazards connected to benzodiazepine usage in CVD patients are fewer than the dangers connected to antidepressant use. 
  • Evidence suggests that benzodiazepines should be used in the treatment of anxiety disorders, possibly as a first-line medication, in patients with CVD, depending on the particular clinical scenario. In silent myocardial ischemia, angina, essential hypertension, and CHF, low-to-moderate dosages of adjunct benzodiazepines appear to be beneficial, particularly in patients with associated anxiety.
  • Serotonin and norepinephrine are neurotransmitters in the brain that are increased by antidepressants. This affects mood and may aid in the treatment of anxiety disorders. According to research, antidepressant type and CVD risk are not different in any way.  An SSRI is an escitalopram (Lexapro). In patients with stable coronary heart disease and anxiety, it is the safest and most effective medication for lowering anxiety.