The HeartBytes dataset is composed of screening data from 7425 patients that ranged from 12 to 20 years old (mean 15). The database is mostly male (60.6%). The patients screened were predominantly White (83.1%) with other represented races including Black (7.2%), Asian/Pacific Islander (3.8%), and Latino/Hispanic (3.2%). The mean body mass index was 20.9. Most of the patients were screened in Pennsylvania (61.6%), followed by New Jersey (18.8%) and then Georgia (9.5%) (Table 1).
Out of the 7,425 patients analyzed in the HeartBytes dataset, 370 participants (5.0%) were diagnosed with anxiety or depression (Table 1). The mean age of these participants was 15.4 years old, and exactly 50% of participants with these conditions were female compared to male. There was no significant difference when compared by self-reported race. A significantly higher percentage of participants without anxiety or depression played sports compared to those with these conditions (89.4% vs. 72.4%, P-value < 0.001). Those with anxiety/depression were also more likely to have ADHD (2.2% vs 0.8%, P-value = 0.019) and asthma (21.9% vs. 17.6%, P-value = 0.041) compared to those without these conditions. There was no significant difference in the rates of diabetes or hypertension between the groups.
In our cohort, 565 (7.6%) were diagnosed with ADHD (Table 1). The mean age of the participants with ADHD was 15.21 years old and most of the participants diagnosed with ADHD were male compared to female (75.4% vs. 59.4%, P-value < 0.001). There was no significant difference when compared by self-reported race. Significantly more participants without ADHD played sports compared to those with ADHD (89.1% vs. 81.2% P-value < 0.001). A significantly higher portion of participants with ADHD took antidepressants (6.4% vs. 1.3%, P-value of < 0.001). There were no significant differences in the prevalence of hypertension, diabetes, or BMI when comparing between participants with and without ADHD.
Table 1: Demographics and tests of differences between individuals with and without anxiety/ depression or ADHD.
|
Has Anxiety/ Depression
|
No Anxiety/ Depression
|
P-value
|
Has ADHD
|
No ADHD
|
P-value
|
Total Participants
|
370
|
7055
|
|
565
|
6860
|
|
Age (mean (SD))
|
15.37 (1.95)
|
15.08 (1.86)
|
0.003
|
15.21 (1.96)
|
15.08 (1.86)
|
0.114
|
Male (%)
|
185 (50.0)
|
4317 (61.2)
|
<0.001
|
426 (75.4)
|
4076 (59.4)
|
<0.001
|
Race (%)
|
|
|
0.303
|
|
|
0.147
|
White
|
317 (86.1)
|
5854 (83.8)
|
N/A
|
485 (85.8)
|
5686 (83.8)
|
N/A
|
Asian/ Pacific Islander
|
6 (1.6)
|
207 (3.0)
|
N/A
|
7 (1.2)
|
206 (3.0)
|
N/A
|
Black
|
21 (5.7)
|
514 (7.4)
|
N/A
|
38 (6.7)
|
497 (7.3)
|
N/A
|
Latino/Hispanic
|
15 (4.1)
|
217 (3.1)
|
N/A
|
17 (3.0)
|
215 (3.2)
|
N/A
|
Other
|
9 (2.4)
|
193 (2.8)
|
N/A
|
18 (3.2)
|
184 (2.7)
|
N/A
|
BMI (mean (SD))
|
21.53 (4.36)
|
21.54 (4.39)
|
0.957
|
21.77 (5.58)
|
21.51 (4.28)
|
0.201
|
Plays Sports (%)
|
268 (72.4)
|
6298 (89.4)
|
<0.001
|
457 (81.2)
|
6109 (89.1)
|
<0.001
|
High Blood Pressure (%)
|
2 (0.5)
|
16 (0.2)
|
0.513
|
1 (0.2)
|
17 (0.2)
|
1.000
|
Asthma (%)
|
81 (21.9)
|
1241 (17.6)
|
0.041
|
118 (20.9)
|
1204 (17.6)
|
0.053
|
Diabetes (%)
|
1 (0.3)
|
19 (0.3)
|
1.000
|
1 (0.2)
|
19 (0.3)
|
0.985
|
Anemia (%)
|
96 (25.9)
|
469 (6.6)
|
<0.001
|
4 (0.7)
|
63 (0.9)
|
0.782
|
ADHD (%)
|
8 (2.2)
|
59 (0.8)
|
0.019
|
|
|
|
Anxiety/Depression (%)
|
|
|
|
96 (17.0)
|
274 (4.0)
|
<0.001
|
Taking Antidepressant (%)
|
99 (26.8)
|
25 (0.4)
|
<0.001
|
36 (6.4)
|
88 (1.3)
|
<0.001
|
ECG abnormalities were present in 194 (2.6%) patients with the most commonly reported being T wave inversion (61 patients, 0.8%) and nonspecific ST-T wave abnormalities (30 patients, 0.4%; Supplemental Table 1).
After adjusting for age, gender, race, BMI, medical conditions of anemia and asthma, and participation in sports, those with anxiety/depression (aOR 1.03, CI 0.48–1.95, P-value = 0.930) and those with ADHD (aOR 0.84, CI 0.45–1.44, P-value = 0.550) were no more likely to have an ECG abnormality compared to the participants without these conditions (Table 2). The same population was no more likely to have syncope with exercise (anxiety/depression: OR 1.75, CI 0.79–3.45, P-value = 0.13) (ADHD: aOR 1.08, CI 0.44–2.26, P-value = 0.84) compared to participants without these conditions. However, those with anxiety/depression (aOR 2.35, CI 1.65–3.28, P-value < 0.001) but not those with ADHD (aOR 1.45, CI 1.02–2.03, P-value = 0.05) were more likely to have experienced palpitations. Lastly, participants with anxiety/depression (aOR 1.92, CI 1.30–2.77, P-value < 0.001) but not ADHD (aOR 1.26, CI 0.87–1.79, P-value = 0.20) were more likely to have any chest pain or dyspnea with exercise (Table 2).
Table 2
Effect of mental health conditions on cardiovascular symptoms.
Mental Health Condition
|
Cardiovascular Outcomes
|
Adjusted Odds Ratio
|
Confidence Interval
|
P-value
|
Anxiety/Depression
|
ECG Abnormalities
|
1.03
|
0.48–1.95
|
0.930
|
Chest Pain or Dyspnea
|
1.92
|
1.30–2.77
|
< 0.001
|
Syncope
|
1.75
|
0.79–3.45
|
0.13
|
Palpitations
|
2.35
|
1.65–3.28
|
< 0.001
|
ADHD
|
ECG Abnormalities
|
0.84
|
0.45–1.44
|
0.550
|
Chest Pain or Dyspnea
|
1.26
|
0.87–1.79
|
0.200
|
Syncope
|
1.08
|
0.44–2.26
|
0.84
|
Palpitations
|
1.45
|
1.02–2.03
|
0.05
|
After adjusting for age, gender, race, BMI, asthma, anemia, and whether the patient plays sports, those who take an antidepressant (aOR 1.10, CI 0.33–2.69, p = 0.85) and those who take a stimulant (aOR 0.53, CI 0.19–1.18, p = 0.17) were no more likely to have an ECG abnormality (Table 3). The same result was found with regards to chest pain and dyspnea with exercise in these populations (aOR 1.54, CI 0.83–2.66, P-value = 0.14 for antidepressants; aOR 1.39, CI 0.87–2.14, P-value = 0.15 for stimulants). In addition, participants who take an antidepressant (aOR 1.66, CI 0.49–4.20, P-value = 0.34) or a stimulant (aOR 0.50, CI 0.01–1.61, p = 0.33) were no more likely to have syncope with exercise. Notably, patients taking an antidepressant (aOR 2.09, CI 1.23–3.36, p < 0.01) were more likely to report palpitations, but not those who take a stimulant (aOR 1.22, CI 0.75–1.89, p = 0.39) (Table 3).
Table 3
Effect of psychiatric medications on cardiovascular symptoms.
Mental Health Medication
|
Cardiovascular Symptom
|
Adjusted Odds Ratio
|
Confidence Interval
|
P-value
|
Antidepressant
|
ECG abnormalities
|
1.10
|
0.33–2.69
|
0.85
|
Chest Pain or Dyspnea
|
1.54
|
0.83–2.66
|
0.14
|
Syncope
|
1.66
|
0.49–4.20
|
0.34
|
Palpitations
|
2.09
|
1.23–3.36
|
< 0.01
|
Stimulant
|
ECG Abnormalities
|
0.53
|
0.19–1.18
|
0.17
|
Chest Pain or Dyspnea
|
1.39
|
0.87–2.14
|
0.15
|
Syncope
|
0.50
|
0.01–1.61
|
0.33
|
Palpitations
|
1.22
|
0.75–1.89
|
0.39
|
We then examined the effects of antidepressants and stimulants on these variables. After again adjusting for age, gender, race, BMI, asthma, anemia, and participation in athletics, those with anxiety/depression not on medication (aOR 2.09, CI 1.31–3.19, p < 0.01), but not those with anxiety and depression on medication (aOR 1.87, CI 0.96–3.33, p = 0.05), were more likely to report chest pain or dyspnea with exercise. Regardless of medication use, those with anxiety/depression were at increased risk of palpitations but not ECG abnormalities (Table 4).
Reported history of ADHD by medication use was then evaluated. After adjustment for confounders, those with ADHD not on stimulants (aOR 1.91, CI 1.22–2.89, p < 0.01), but not those on a stimulant (aOR 1.40, CI 0.82–2.24, p = 0.19), were at increased risk for palpitations compared to those without ADHD. In those with ADHD regardless of prescribed medication, no difference was present for ECG abnormalities or chest pain/dyspnea with exercise compared to those without ADHD (Table 4).
Table 4: Effect of medications on youth athletes diagnosed with mental health conditions.
|
No anxiety/depression
|
Anxiety/depression on Medication
|
p-value
|
Anxiety/depression not on Medication
|
p-value
|
ECG Abnormalities
|
--
|
0.65 (0.11 – 2.07)
|
0.55
|
1.18 (0.49 – 2.37)
|
0.68
|
Chest Pain or Dyspnea
|
--
|
1.87 (0.96 – 3.33)
|
0.05
|
2.09 (1.31 – 3.19)
|
<0.01
|
Palpitations
|
--
|
2.18 (1.19 – 3.73)
|
<0.01
|
2.69 (1.78 – 3.95)
|
<0.001
|
|
|
|
No ADHD
|
ADHD on stimulant
|
|
ADHD not on stimulant
|
p-value
|
ECG Abnormalities
|
--
|
0.66 (0.23 – 1.46)
|
0.36
|
1.02 (0.45 – 1.97)
|
0.96
|
Chest Pain or Dyspnea
|
--
|
1.50 (0.90 – 2.38)
|
0.10
|
1.31 (0.79 – 2.07)
|
0.27
|
Palpitations
|
--
|
1.40 (0.82 – 2.24)
|
0.19
|
1.91 (1.22 – 2.89)
|
<0.01
|