Cardiac Events Doubled Among Distressed Younger Survivors of
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
As compared with older patients, young adults who have survived a myocardial infarction (MI) have a higher burden of psychological adversity. Researchers hypothesize that among young and middle age survivors of MI, those with high distress will have worse outcomes and inflammatory markers will play a role in the increased risk.

Researchers studied 283 patients ages 18 to 61 within 8 months of MI. A composite psychological distress score was constructed using standardized questionnaires of depression, anxiety, anger, perceived stress and posttraumatic stress disorder, and categorized into tertiles (mild/moderate/high distress). Patients were followed for 5 years for major adverse cardiovascular events (MACE), which included independently adjudicated MI, stroke, heart failure hospitalization, or cardiovascular death. Cox proportional-hazard models were used to estimate the association of the psychological distress score with MACE with adjustment for demographic, clinical risk factors, and interleukin-6 and monocyte chemoattract protein-1 to investigate the role of inflammation.

-- The mean age was 51 (range 22-61), 64% were Black and 50% were women.

-- Compared with patients with mild distress, those with high distress were more often Black, female, and from a more disadvantaged socioeconomic background.

-- They also had a greater burden of risk factors including diabetes, hypertension, and smoking.

-- A positive association between inflammatory markers and psychological distress score was observed.

-- A total of 80 patients developed MACE. The incidence was more than doubles in those with high distress (47%) than in mild distress (22%).

-- This association was minimally attenuated by adjusting for demographic factors.

-- After adjustment for clinical risk factors the association was attenuated and no longer significant after adjusting for inflammatory markers.

Conclusively, among young and middle-aged survivors of MI, psychological distress is associated with an increased risk of MACE at 5-years. Mechanisms involving inflammation may be implicated.