Elsevier

Biological Psychiatry

Volume 60, Issue 8, 15 October 2006, Pages 837-842
Biological Psychiatry

Original article
Acute Depressed Mood as a Trigger of Acute Coronary Syndromes

https://doi.org/10.1016/j.biopsych.2006.03.041Get rights and content

Background

Some cases of acute coronary syndrome (ACS) may be triggered by emotional states such as anger, but it is not known if acute depressed mood can act as a trigger.

Methods

295 men and women with a verified ACS were studied. Depressed mood in the two hours before ACS symptom onset was compared with the same period 24 hours earlier (pair-matched analysis), and with usual levels of depressed mood, using case-crossover methods.

Results

46 (18.2%) patients experienced depressed mood in the two hours before ACS onset. The odds of ACS following depressed mood were 2.50 (95% confidence intervals 1.05 to 6.56) in the pair-matched analysis, while the relative risk of ACS onset following depressed mood was 4.33 (95% confidence intervals 3.39 to 6.11) compared with usual levels of depressed mood. Depressed mood preceding ACS onset was more common in lower income patients (p = .032), and was associated with recent life stress, but was not related to psychiatric status.

Conclusions

Acute depressed mood may elicit biological responses that contribute to ACS, including vascular endothelial dysfunction, inflammatory cytokine release and platelet activation. Acute depressed mood may trigger potentially life-threatening cardiac events.

Section snippets

Participants

Participants were 295 patients admitted with an ACS to four hospitals in the London area. The inclusion criteria were a diagnosis of ACS based on the presence of chest pain plus verification by diagnostic electrocardiographic (EKG) changes (new ST elevation >0.2 mV in 2 contiguous leads in leads V1, V2 or V3 and >0.1 mV in 2 contiguous other leads, ST depression >0.1 mV in 2 contiguous leads in the absence of any QRS confounders, new left bundle branch block or dynamic T wave inversion in more

Results

The mean age of patients was 60.4 years ± 11.1 (SD), and 231 men and 64 women participated. The majority (200 cases, 67.8%) was diagnosed with STEMI, with 95 admissions for NSTEMI/ UA. 32 patients (10.8%) had previously suffered an MI, and 44 (14.7%) had a prior diagnosis or treatment for CHD. Few patients had been medicated with beta-blockers (17.5%) or aspirin (20.7%) before the ACS, but the majority were taking statins (88.1%). Sixty (20.3%) patients had a positive lifetime history of

Discussion

Emotional triggers of ACS have been investigated in two ways: by interviewing survivors as was done here, or by assessing cardiac events following large scale stressors such as earthquakes and terrorist attacks (Strike and Steptoe 2005). Two previous studies have used case-crossover methods to identify an association between acute anger and triggering of MI. In the Onset study, the odds of acute MI after severe anger in the 2 h before symptoms were 4.0 (C.I. 1.9–9.4) in pair-matched analysis,

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    This research was supported by the British Heart Foundation. We acknowledge the contribution of Susan Edwards to data collection, and are grateful to Dr. Jette Möller for advice about the statistical analysis. No competing interests are declared.

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