Abstract
Background: Considering the association of inflammation with suicide and acute coronary syndrome (ACS), we investigated the individual and interactive effects of serum tumor necrosis factor-alpha (sTNFα) levels and two polymorphisms (−850 C/T and −308 G/A) on suicidal ideation (SI) after ACS.Methods: The SI status using items on the Montgomery–Åsberg Depression Rating Scale (MADRS), related covariates including sociodemographic and clinical characteristics, sTNFα levels, and tumor necrosis factor-alpha (TNF-α) polymorphisms were evaluated in 969 patients within 2 weeks after ACS. Of the patients, 711 were evaluated 1 year later for SI. Multivariate logistic regression models were used to calculate individual and interactive associations after adjusting for the covariates.Results: Higher (vs. lower) sTNFα levels and the −850 C/T or T/T (vs. C/C) polymorphism were significantly associated with SI 2 weeks after ACS, while only higher sTNFα levels were significantly associated with SI after 1 year. Significant interactive effects were detected between sTNFα (higher) levels and the −850 C/T (C/C or C/T) polymorphism on SI 2 weeks after ACS and between the two (−850 CC or CT and −308 G/A or AA) polymorphisms on SI 1 year after ACS.Conclusions: The sTNFα level and two polymorphisms (−850C/T and −308 G/A), separately or in combination, could be time-specific biomarkers for SI in ACS. Focused interventions for ACS patients at risk of SI might reduce the suicidal burden in patients with ACS.
Highlights
Suicide is a global health issue, and much effort has been dedicated to identify patients at risk of suicide and devise preventive strategies
The K-DEPACS study included patients males and females aged 18–85 years, diagnosed with acute coronary syndrome (ACS) [ST-segment elevation myocardial infarction (MI) was diagnosed on the basis of continuous chest pain ≥30 min, a new ST-segment elevation ≥2 mm on ≥2 contiguous electrocardiographic leads, and creatine kinase-MB (CK-MB) values ≥3 × normal limit; non-ST-segment elevation MI was diagnosed on the basis of chest pain and an increase in cardiac biochemical marker, without new ST-segment elevation; and unstable angina was diagnosed on the basis of chest pain within the last 72 h with or without ST-T segment changes or an increase in cardiac biochemical markers] and able to complete the questionnaires, understand the objectives of the study, and provide written, informed consent
All patients (N = 4,809) admitted with a recent ACS were approached for study participation
Summary
Suicide is a global health issue, and much effort has been dedicated to identify patients at risk of suicide and devise preventive strategies. No markers have been validated to predict SI, where suicide is a complex, multifactorial phenomenon involving interactions between various environmental stressors (e.g., childhood adversities and physical illness) and individual factors including hopelessness, temperament, and biological mechanisms. Lifethreatening physical illnesses, including acute coronary syndrome (ACS), are risk factors for suicide because of their psychological (e.g., hopelessness and psychiatric comorbidities) and biological (e.g., inflammation and a heightened stress response due to HPA axis activity) effects [5, 6]. Considering the association of inflammation with suicide and acute coronary syndrome (ACS), we investigated the individual and interactive effects of serum tumor necrosis factor-alpha (sTNFα) levels and two polymorphisms (−850 C/T and −308 G/A) on suicidal ideation (SI) after ACS
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