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Patients with CHD, stress, depression at elevated short-term risk for MI, death
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Adults with CHD and concurrent symptoms of stress and depression had an elevated risk for MI and death during the first 2.5 years of follow-up, researchers reported in a recent study.
Based on a “psychosocial perfect storm conceptual model,” researchers hypothesized that amplified risk would occur in patients with CHD who had concurrent stress and depressive symptoms.
The study included 4,487 adults aged 45 years and older with CHD from the REGARDS prospective cohort study. The outcome of interest was a composite of MI and death.
At baseline, 6.1% of participants reported concurrent high stress and high depressive symptoms. During a median 5.95 years of follow-up, 1,337 events occurred. In the first 2.5 years of follow-up, those with CHD and concurrent high stress and high depressive symptoms had an increased risk for MI or death compared with those with CHD and low stress and low depressive symptoms (adjusted HR=1.48; 95% CI, 1.08-2.02).
“The increase in risk accompanying high stress and high depressive symptoms was robust and consistent across demographics, medical history, medication use and health risk behaviors,” Carmela Alcántara, PhD, associate research scientist at Columbia University Medical Center for Behavioral Cardiovascular Health, said in a press release.
The elevated risk was not observed in participants with low stress and high depressive symptoms (adjusted HR = 0.92; 95% CI, 0.66-1.28) or participants with high stress and low depressive symptoms (adjusted HR = 0.86; 95% CI, 0.57-1.29), according to the researchers.
After the initial 2.5 years of follow-up, the association of MI or death with high stress and high depressive symptoms was attenuated (adjusted HR = 0.89; 95% CI, 0.65-1.22).
“Behavioral interventions that teach CHD patients how to adaptively manage stress and depressive symptoms during the high vulnerability period might be particularly important for lowering risk of death, particularly [CV] death, in the shorter term,” Alcántara and colleagues wrote. – by Erik Swain
Disclosure: Two researchers report receiving salary support from Amgen for research studies. One researcher reports consulting for DiaDexus.
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