Abstract
While there is good evidence that symptoms of depression determine prognosis of patients with coronary heart disease (CHD), the role of psychological stress is less clear. We evaluated the prognostic value of stressful events in patients with initial myocardial infarction (MI) with respect to subsequent cardiovascular events. The KAROLA-study included patients with CHD who participated in an in-patient rehabilitation program. A total of 577 patients with initial MI were included and self-reported psychological stressful events before their MI was assessed by a structured questionnaire. Hazard ratios were used to evaluate the long-term association of stressful events with secondary cardiovascular events. Additionally, associations of stressful events with depression, anxiety and other cardiovascular risk factors were investigated. Unusual stress at work (26.5%) and sleep disorder (23.4%) were the most frequently reported stressful events that occurred in the last 4 weeks before MI. However, only death of a family member showed a statistically significant increase in risk for subsequent cardiovascular events (HR: 1.59; 95%-CI: 1.01–2.50) and this result was not corrected for multiple testing. Notably, we found higher symptom scores of anxiety and depression associated with all single stressful event items. In conclusion, we found no clear patterns that psychological stressful events before MI would increase the long-term risk of subsequent adverse CHD events directly. However, we saw increased symptom scores of anxiety and depression in persons with stressful events.
Highlights
Patients with coronary heart disease (CHD) often report symptoms of depression and anxiety [1,2]
We investigated the association of psychological stressful events with suspected cardiovascular risk factors such as body mass index (BMI), diastolic and systolic resting blood pressure, lipid parameters, cotinine level in serum, C-reactive protein, NT-proBNP, hs-cTnT, and symptom scores of depression and anxiety
We found higher symptom scores of anxiety and depression associated with all single stressful event items
Summary
Patients with coronary heart disease (CHD) often report symptoms of depression and anxiety [1,2]. A higher priority is given to psychosocial factors in recent cardiologic guidelines, and mental health risk factors such as depression are established risk and prognostic factors for CHD. They seem to be under-recognized in their importance, and are often not incorporated in secondary prevention strategies in clinical practice, especially during follow-up care [4]. Little data exists about the prevalence and the role of psychological stress and trauma as triggers of acute events and even less about their role as prognostic factors for long-term outcomes. Key questions about directionality and possible causal relationships are still open [5]
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