Depression and disease severity in patients with premature acute coronary syndrome
Roxanne Pelletier1, Kim L Lavoie2, Simon L Bacon3
1Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
Insights
Major depression did not correlate with cardiovascular disease severity in young acute coronary syndrome patients. The study found no sex differences in this association, suggesting other factors contribute to adverse events in depressed individuals.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Premature acute coronary syndrome (ACS) affects younger populations.
- The link between depression and cardiovascular disease (CVD) severity in young ACS patients is understudied.
- Sex differences in this association are unknown.
Purpose of the Study:
- To determine if major depression and depressive symptoms are associated with worse CVD severity in patients with premature ACS.
- To investigate potential sex differences in these associations.
Main Methods:
- 1023 patients (age ≤ 55 years) hospitalized with ACS were enrolled from 26 centers across North America and Switzerland.
- Data on left ventricular ejection fraction, Killip class, cardiac troponin I, and Global Registry of Acute Coronary Events score were collected.
- The GENdEr and Sex determInantS of cardiovascular disease (GENDER-ACS) study provided the patient cohort.
Main Results:
- Major depression was initially associated with lower likelihood of abnormal left ventricular ejection fraction and lower troponin I levels in univariate analysis.
- After adjusting for sociodemographic and clinical factors, neither major depression nor depressive symptoms were linked to disease severity indices.
- No significant sex differences were observed in the associations between depression and CVD severity.
Conclusions:
- Cardiovascular disease severity does not explain the increased risk of adverse events in depressed patients with premature ACS.
- Depression's impact on adverse events in young ACS patients may be mediated by factors other than disease severity.
Objectives:
The association between depression and cardiovascular disease severity in younger patients has not been assessed, and sex differences are unknown. We assessed whether major depression and depressive symptoms were associated with worse cardiovascular disease severity in patients with premature acute coronary syndrome, and we assessed sex differences in these relationships.
Methods:
We enrolled 1023 patients (aged ≤ 55 years) hospitalized with acute coronary syndrome from 26 centers in Canada, the United States, and Switzerland, through the GENdEr and Sex determInantS of cardiovascular disease: From bench to beyond-Premature Acute Coronary Syndrome study. Left ventricular ejection fraction, Killip class, cardiac troponin I, and Global Registry of Acute Coronary Events score data were collected through chart review.
Results:
The sample comprised 248 patients with major depression and 302 women. In univariate analyses, major depression was associated with a lower likelihood of having an abnormal left ventricular ejection fraction (odds ratio, 0.70; 95% confidence interval, 0.51-0.97; P = .03) and lower troponin I levels (estimate, -4.04; 95% confidence interval, -8.01 to -0.06; P = .05). After adjustment for sociodemographic and clinical characteristics, neither major depression nor depressive symptoms were associated with disease severity indices, and there were no sex differences.
Conclusion:
The increased risk of adverse events in depressed patients with premature acute coronary syndrome is not explained by disease severity.
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