Depression, C-reactive Protein and Two-year Major Adverse Cardiac Events in Men after Acute Coronary Syndromes

doi:10.1016/j.biopsych.2006.09.029

Biological Psychiatry

Volume 62, Issue 4, 15 August 2007, Pages 302-308

https://doi.org/10.1016/j.biopsych.2006.09.029 Get rights and content

Background

We investigated the impact of depression and inflammatory markers, assessed 2 months after acute coronary syndrome (ACS), on major adverse cardiac events over 2 years (MACEs; cardiac death, survived myocardial infarction, survived cardiac arrest, and nonelective revascularization).

Methods

Depression symptoms (Beck Depression Inventory-II; BDI-II), major depression, C-reactive protein (CRP), interleukin-6, and soluble intercellular adhesion molecule were assessed in 741 ACS patients (including 602 men).

Results

Some 102 (78 men) experienced at least one MACE. Beck Depression Inventory-II scores of ≥14 predicted MACEs (p = .007). The increase in risk was marked in men (hazard ratio [HR] = 1.96, 95% confidence interval [CI] = 1.24–3.09, p = .004), with little evidence of a relationship in women (p = .85). Subsequent analyses were limited to men. Results were similar after covariate adjustment (HR = 1.72, 95% CI = 1.07–2.77, p = .024). C-reactive protein levels were also associated with increased MACE risk (adjusted HR for CRP ≥ 2.0 mg/L = 1.67, 95% CI = 1.07–2.62, p = .025). C-reactive protein levels and BDI-II scores interacted in predicting MACEs. Men with both BDI-II scores of ≥14 and CRP of ≥2.0 mg/L experienced an increase in risk similar to those with only one of these factors.

Conclusions

In men assessed 2 months after ACS, depression and CRP are overlapping prognostic risks. Patients with either risk may benefit from similar therapies.

Section snippets

Subjects

The Epidemiological Study of Acute Coronary Syndromes and the Pathophysiology of Emotions (ESCAPE) received approval from the Research Ethics Committees of the Montreal Heart Institute and Hôpital du Sacré Coeur de Montréal. Patients from both hospitals who underwent a coronary angiogram during admission for a suspected acute myocardial infarction (MI) or episode of unstable angina with elevated troponin-T levels (based on each hospital’s laboratory standards) between August 31, 1999 and August

Sample Characteristics

The sample of 741 included 602 (81.2%) men. Patients ranged in age from 24 to 90 years (mean = 59.8 y). Overall 201 participants (27.1%) had BDI-II scores of ≥14 (25.2% of men, n = 152; 35.3% of women, n = 49; p = .017). Results of the SCID showed that 46 subjects met criteria for current unipolar major depression (4.5% of men, n = 27; 13.7% of women, n = 19; p < .001).

Depression and MACEs

A total of 102 patients (78 men, 24 women; p = .41) experienced at least one MACE during the 2-year follow-up period (10

Discussion

This prospective study was designed to confirm the negative impact of depression on cardiac prognosis in patients after an ACS admission and to investigate the relationships between depression and markers of inflammation in predicting subsequent cardiac events. Even though depression was assessed several weeks after hospital discharge, both elevated scores on the BDI-II scale and current major unipolar depression were significantly related to MACEs over 2 years. We also observed a tendency for

Conclusions

When multiple risk factors co-occur in the same individuals, untangling their separate contributions can be very difficult (Kraemer et al. 2005). The current study underscores this complex bidirectional relationship between depression and inflammation. Given our finding of overlap between depression and inflammation in predicting prognosis in stable ACS patients, it would be of interest to determine the extent to which patients with elevated inflammatory markers, with depression, or with both

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Original ArticleDepression, C-reactive Protein and Two-year Major Adverse Cardiac Events in Men after Acute Coronary Syndromes

Background

Methods

Results

Conclusions

Section snippets

Subjects

Sample Characteristics

Depression and MACEs

Discussion

Conclusions

Brain Behav Immun

J Psychosom Res

Biol Psychiatry

Brain Behav Immun

Methods Neurosci

Biol Psychiatry

Brain Behav Immun

Am J Cardiol

Biol Psychiatry

Clin Chim Acta

Biol Psychiatry

Manual for the Beck Depression Inventory-II

Effects of exercise training on older patients with major depression

Arch Intern Med

Protocol for the bypass angioplasty revascularization investigation

Circulation

Association between depression and elevated C-reactive protein

Psychosom Med

Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: The Prospective Epidemiological Study of Myocardial Infarction (PRIME)

Circulation

Original Article
Depression, C-reactive Protein and Two-year Major Adverse Cardiac Events in Men after Acute Coronary Syndromes