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Acute stress disorder and C-reactive protein in patients with acute myocardial infarction


Bielas, Hannes; Meister-Langraf, Rebecca E; Schmid, Jean-Paul; Barth, Jürgen; Znoj, Hansjörg; Schnyder, Ulrich; Princip, Mary; von Känel, Roland (2018). Acute stress disorder and C-reactive protein in patients with acute myocardial infarction. European Journal of Preventive Cardiology, 25(3):298-305.

Abstract

Background: Myocardial infarction-triggered acute stress disorder (ASD) and subclinical inflammation associate with the development of posttraumatic stress disorder, and worsen the prognosis of myocardial infarction patients. We examined the relationship between ASD severity and C-reactive protein levels in patients with acute myocardial infarction.
Method: We assessed 190 patients (median age 59 years; 83% men) with a verified myocardial infarction within 48 h of an acute coronary intervention. Circulating levels of C-reactive protein were categorized according to their prognostic risk for cardiovascular disease: 0 to <5, 5 to <10, 10 to <20, and ≥ 20 mg/l. Patients completed the ASD-Scale (ASDS) for myocardial infarction-triggered symptoms and questionnaires for demographic factors, health behaviours, cardiac-related variables and psychosocial characteristics.
Results: The ASDS sum score was positively associated with C-reactive protein categories in the bivariate analysis (r = 0.20, p < 0.01). Significant relationships with C-reactive protein also emerged for dissociation (r = 0.25, p < 0.001) and avoidance (r = 0.19, p < 0.01), but not for arousal and re-experiencing. Similarly, C-reactive protein levels ≥ 20 mg/l versus < 20 mg/l were predicted by the ASDS sum score, and the dissociation, avoidance and arousal subscores (all p-values < 0.05) in the fully adjusted binary regression analyses. C-reactive protein levels ≥ 20 mg/l were also independently predicted by male gender, body mass index, lower education, and lower left ventricular ejection fraction and higher white blood cell count.
Conclusions: Higher levels of myocardial infarction-triggered ASD symptoms associate with a greater inflammatory response in patients with acute myocardial infarction independently of important covariates. The findings suggest a link between myocardial infarction-triggered ASD symptoms and a heightened acute phase response with a potential impact on cardiovascular disease prognosis.

Abstract

Background: Myocardial infarction-triggered acute stress disorder (ASD) and subclinical inflammation associate with the development of posttraumatic stress disorder, and worsen the prognosis of myocardial infarction patients. We examined the relationship between ASD severity and C-reactive protein levels in patients with acute myocardial infarction.
Method: We assessed 190 patients (median age 59 years; 83% men) with a verified myocardial infarction within 48 h of an acute coronary intervention. Circulating levels of C-reactive protein were categorized according to their prognostic risk for cardiovascular disease: 0 to <5, 5 to <10, 10 to <20, and ≥ 20 mg/l. Patients completed the ASD-Scale (ASDS) for myocardial infarction-triggered symptoms and questionnaires for demographic factors, health behaviours, cardiac-related variables and psychosocial characteristics.
Results: The ASDS sum score was positively associated with C-reactive protein categories in the bivariate analysis (r = 0.20, p < 0.01). Significant relationships with C-reactive protein also emerged for dissociation (r = 0.25, p < 0.001) and avoidance (r = 0.19, p < 0.01), but not for arousal and re-experiencing. Similarly, C-reactive protein levels ≥ 20 mg/l versus < 20 mg/l were predicted by the ASDS sum score, and the dissociation, avoidance and arousal subscores (all p-values < 0.05) in the fully adjusted binary regression analyses. C-reactive protein levels ≥ 20 mg/l were also independently predicted by male gender, body mass index, lower education, and lower left ventricular ejection fraction and higher white blood cell count.
Conclusions: Higher levels of myocardial infarction-triggered ASD symptoms associate with a greater inflammatory response in patients with acute myocardial infarction independently of important covariates. The findings suggest a link between myocardial infarction-triggered ASD symptoms and a heightened acute phase response with a potential impact on cardiovascular disease prognosis.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Complementary Medicine
04 Faculty of Medicine > University Hospital Zurich > Klinik für Konsiliarpsychiatrie und Psychosomatik
04 Faculty of Medicine > Institute of Biomedical Ethics and History of Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Epidemiology
Health Sciences > Cardiology and Cardiovascular Medicine
Uncontrolled Keywords:Cardiovascular disease, inflammation, psychobiology, risk factor, trauma stress
Language:English
Date:2018
Deposited On:27 Dec 2017 16:53
Last Modified:08 Apr 2020 22:15
Publisher:Sage Publications Ltd.
ISSN:2047-4873
OA Status:Green
Publisher DOI:https://doi.org/10.1177/2047487317748506
PubMed ID:29243511

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