Association between anxiety state and mitral valve disorders: A Taiwanese population-wide observational study

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Highlights

  • Phenome-wide association study was used to investigate the association between anxiety state (AS) and mitral valve disorders (MVD) among Taiwanese population.

  • A stronger association between AS and MVD was found in younger age group than in the elderly age group.

  • A higher incidence of co-occurrence in females than males, particularly in age group of 40–49.

Abstract

Background and objective

Despite substantial research progress in concurrent diseases, for instance comorbidities involving anxiety state (AS) and mitral valve disorders (MVD), the current measures and care are limited and no consensus about their association has yet been reached. Hence, this study aims to analyze the prevalence and association between AS and MVD among Taiwanese population.

Methods

We employed phenome-wide association study (PWAS) portal to investigate the association between AS and MVD using claim data of Taiwan's National Health Insurance Research Database (NHIRD) from year 2000 to 2002. Association strength between AS and MVD was analyzed among overall age and gender groups.

Results

We found an overall stronger association between AS and MVD, which was significantly higher in younger age group (OR 15, 95% CI 14.82–16.88) than in the elderly age group (OR 1.99, 95% CI 1.76–2.24). Also, the study reveals a higher incidence of co-occurrence in females than males, particularly in age group of 40–49.

Conclusions

Based on our results showing considerable strength of association between AS and MVD, this study suggests the necessity of MVD assessment in all patients with AS, particularly in younger females. Moreover, we also propose psychotherapeutic as well as pharmacologic intervention for comorbidity-based pathologies to better the quality care for high-need Taiwanese population.

Introduction

Anxiety is part of human lifetime experience but the anxious manifestation is abnormal when exaggerated, leading to a psychopathological state. In particular, cardiovascular complaints in anxiety state (AS) have been known for a long time [1]. Mitral valve disorders (MVD), a type of valvular dysfunction commonly associated with AS, are one of the most prevalent cardiovascular aberrations. In particular, annual occurrence of MVD has been reported in 2%–3% of the general population with sudden cardiac death rate ranging 0.2%–0.4% per year [2], [3]. Hence, it is hypothesized that anxiety, an emotionally charged event, may be a contributing factor for episodes of cardiovascular complications like MVD. Therefore, the interest in the co-occurrence of AS and MVD has grown in recent years worldwide.

In spite of an elevated interest in comorbid states involving AS and MVD, relatively fewer research has been focused on treatment regimen and most of the therapies have emphasized traditional medications. In some published studies, no incidence of association between AS and MVD was reported [4] leading to limited attention to remedies addressing comorbid symptoms. Hence, an assessment of psycho-emotional status in addition to valvular dysfunction is cardinal.

Importantly, during meta-analysis of the data available from published literature, the issues such as sample size, inclusion and exclusion criteria of the sample, and period of study conducted pose obstacles for validation and generalized synthesis of the results. Therefore, to mitigate the biases of previous reports, this study attempts to use population-wide observational e-claim data from Taiwan's NHIRD.

Section snippets

Data sources

National Health Insurance Research Database (NHIRD) established by the National Health Research Institute (http://nhird.nhri.org.tw/en), Taiwan, commenced National Health Insurance (NHI) program in 1995. NHIRD contains data of more than 23 million people, which is 99% of Taiwan's entire population [5]. This study used a phenome-wide association strengths (PWAS) portal (Fig. 1) that was generated using the patient phenotypes information retrieved from NHIRD to explore the disease-wide

Results

To date, this is the first large-scale nationwide population-based analysis to investigate association between AS and MVD among Taiwanese. In the present study, the co-occurrence of AS and MVD among Taiwanese population has been categorized according to their gender and age. Fig. 1 depicts the screenshot of PWAS portal displaying gender and age groups of comorbid conditions including AS and MVD, the resultant co-occurrence, OR and P-value while Fig 2 demonstrates the graphical representation of

Discussion

Despite advancement in the medical sciences, there is still a limited understanding on the pathogenesis of diseases and their associations [8]. Using phenome-wide association studies (PWAS) approach, we developed a comprehensive database that can be accessed online at http://associations.phr.tmu.edu.tw/index.php/ [6], which provides an estimate of disease associations. Another interesting advantage of PWAS utility is that it confers disease associations among all age groups and in both genders.

Conclusions

This population-wide observational database shows that there is a stronger association between AS and MVD in the younger than the elderly age group. Furthermore, the incidence of comorbidity of AS and MVD was highly associated with females. Since these comorbid pathologies are associated with psycho-cardiological abnormality, combined psychotherapeutic and pharmacological treatment approaches are suggested. Based on our overall findings, we conclude that all the patients diagnosed with AS

Conflict of interest

The authors have no conflict of interest.

Acknowledgements

This research is sponsored in part by National Science Council, Taiwan (NSC) under grant NSC 99-2511-S-038-005-MY3; Ministry of Health and Welfare (MOHW), Taiwan, under grant MOHW103-TDB-111-01; Taipei Medical University under grants 99TMU-WFH-10, 101TMU-SHH-21, and TMU102-AE1-B31; Taipei Medical University and Taipei Medical University Hospital (101-TMU-TMUH-03); and Ministry of Education, Taiwan, under grant TMUTOP103006-6.

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    These two authors have equally contributed to this work.

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