Psychological distress confers elevated risk for subsequent CV events in younger adults
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Among young and middle-aged survivors of MI, psychological distress was associated with elevated risk for major adverse CV events at 5 years, according to a presentation at the American College of Cardiology Scientific Session.
“Observational studies have suggested that stress is associated with adverse outcomes. However, stress seems to have a particularly important role as disease trigger in high-risk populations with established coronary disease, suggesting that in this population, stress has a larger role as a determinant of prognosis and outcome more so as a contributor of disease development,” Mariana Garcia, MD, a cardiology fellow at Emory University, said during a consumer web briefing.
“Our study objectives were to, among young and middle-aged survivors of MI, investigate the association between a composite measure of psychological distress and recurrent CV events and to explore whether enhanced inflammatory response to acute psychological stress may mediate this effect,” Garcia said during the briefing.
Researchers analyzed 283 patients aged 18 to 61 years (mean age, 51 years; 64% Black; 50% women) who were within 8 months of MI and followed them for 5 years for major adverse CV events, defined as MI, stroke, HF hospitalization or CV death.
According to the researchers, compared with patients with mild distress, those with severe distress were more likely to be Black, female and from a disadvantaged socioeconomic background.
Patients with severe distress had a greater burden of risk factors, including diabetes, hypertension and smoking, compared with those with mild distress. The researchers detected a positive link between inflammatory markers and psychological distress score.
In the analysis of the study population, 80 patients developed major adverse CV events and the incidence was more than double in those with severe distress (37%) compared with mild distress (17%; HR = 2.7; 95% CI, 1.5-4.9).
According to the researchers, the link was minimally attenuated after adjustment for demographic factors (HR = 2.5; 95% CI, 1.4-4.6) and after adjustment for clinical risk factors (HR = 1.9, 95% CI, 1-3.7) and was no longer significant after adjustment for inflammatory markers (HR = 1.8; 95% CI, 0.7-3.3).
“Outreach to the community has led to increased awareness of traditional heart disease risk factors and focus on things like diet and exercise, but many people, particularly younger people, may not be aware of the importance of mental health. Our study offers a strong message to people recovering from a heart attack that ameliorating psychological distress may be equally important,” Garcia said in a press release.
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Garcia M, et al. Risk characterization in ischemic heart disease. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting).
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