Stress level in patients with coronary heart disease and type 2 diabetes mellitus in wartime conditions

Abstract

Objective — to assess the levels of stress disorders and anxiety and their relationship with metabolic disorders and indicators of adipose tissue accumulation in civilian patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) during military operations.
 Materials and methods. Examinations involved 106 civilians who have permanently lived in the city of Kharkiv and the unoccupied part of the Kharkiv region since the beginning of the war. The study included 44 patients with stable CHD and T2DM, 40 patients with CHD without diabetes, and 22 individuals of the control group without coronary artery disease and diabetes. Questionnaire survey was performed with the use of scales for assessing symptoms of post‑traumatic stress disorder (PTSD) (PCL‑5 scale), the Generalized Anxiety Disorder (GAD‑7), and the perceived stress scale (PSS‑10). The body mass index was determined, the level of visceral fat, the percentage of total body fat mass, and the percentage of muscle mass of the body were measured by the bioimpedance method. The levels of lipids, insulin, blood glucose, glycated hemoglobin were determined, and the HOMA‑IR index was calculated.
 Results. According to the results of the survey on the PCL‑5 scale, CHD patients with T2DM had the highest score, which significantly exceeded the indicators of the control group (p=0.014) and CHD patients without diabetes (p=0.037). Among patients with coronary heart disease with diabetes, the largest proportion of patients with signs of probable PTSD was noted (27.77%), while in the control group such persons were 9.09% (p=0.089), and in the group of patients with CHD without diabetes this position was 7.50% (р=0.018). The level of general anxiety according to the GAD‑7 scale in CHD patients with T2DM, in CHD patients without diabetes, and in the control group was almost the same and met the criteria for moderate anxiety. The sum of points on the PSS‑10 perceived stress scale in CHD patients with T2DM was greater than in the control group (p=0.047) and CHD patients without diabetes (p=0.097)) and corresponded to the average level of stress. In patients with CHD with T2DM with probable PTSD glycated hemoglobin level was higher than in patients without probable PTSD (p=0.037). In patients with CHD with T2DM positive correlations between the sum of points on the PTSD scale and the level of total cholesterol and non‑high‑density lipoprotein cholesterol, between the sum of points on the PSS‑10 scale and the level of visceral fat were revealed. The sum of points on the GAD‑7 scale was negatively correlated with muscle mass.
 Conclusions. In in the conditions of war in Ukraine civilian patients with CHD with T2DM have more pronounced psychoemotional disorders than healthy individuals of the control group and patients with CHD without diabetes. In patients with CHD with T2DM, an increase in the degree of psychoemotional disorders was associated with worsening glycemic control and lipid parameters, with the accumulation of visceral fat and a decrease in muscle mass.