Original Article| Volume 62, ISSUE 4, P302-308, August 15, 2007

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Depression, C-reactive Protein and Two-year Major Adverse Cardiac Events in Men after Acute Coronary Syndromes

  • Nancy Frasure-Smith
    Address reprint requests to Nancy Frasure-Smith, Ph.D., McGill University, Department of Psychiatry, 1033 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1
    Department of Psychiatry and School of Nursing, McGill University, Montreal, Canada

    Montreal Heart Institute Research Center, Montreal, Canada

    Centre Hospitalier de l’Université de Montréal Research Center, Montreal, Canada

    Department of Psychiatry, University of Montreal, Montreal, Canada
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  • François Lespérance
    Montreal Heart Institute Research Center, Montreal, Canada

    Centre Hospitalier de l’Université de Montréal Research Center, Montreal, Canada

    Department of Psychiatry, University of Montreal, Montreal, Canada
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  • Michael R. Irwin
    Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience, University of California at Los Angeles, Los Angeles, California
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  • Claude Sauvé
    Department of Medicine, University of Montreal, Montreal, Canada

    Department of Medicine, Hôpital du Sacré Coeur, Montreal, Canada.
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  • Jacques Lespérance
    Montreal Heart Institute Research Center, Montreal, Canada
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  • Pierre Théroux
    Montreal Heart Institute Research Center, Montreal, Canada

    Department of Medicine, University of Montreal, Montreal, Canada
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      We investigated the impact of depression and inflammatory markers, assessed 2 months after acute coronary syndrome (ACS), on major adverse cardiac events over 2 years (MACEs; cardiac death, survived myocardial infarction, survived cardiac arrest, and nonelective revascularization).


      Depression symptoms (Beck Depression Inventory-II; BDI-II), major depression, C-reactive protein (CRP), interleukin-6, and soluble intercellular adhesion molecule were assessed in 741 ACS patients (including 602 men).


      Some 102 (78 men) experienced at least one MACE. Beck Depression Inventory-II scores of ≥14 predicted MACEs (p = .007). The increase in risk was marked in men (hazard ratio [HR] = 1.96, 95% confidence interval [CI] = 1.24–3.09, p = .004), with little evidence of a relationship in women (p = .85). Subsequent analyses were limited to men. Results were similar after covariate adjustment (HR = 1.72, 95% CI = 1.07–2.77, p = .024). C-reactive protein levels were also associated with increased MACE risk (adjusted HR for CRP ≥ 2.0 mg/L = 1.67, 95% CI = 1.07–2.62, p = .025). C-reactive protein levels and BDI-II scores interacted in predicting MACEs. Men with both BDI-II scores of ≥14 and CRP of ≥2.0 mg/L experienced an increase in risk similar to those with only one of these factors.


      In men assessed 2 months after ACS, depression and CRP are overlapping prognostic risks. Patients with either risk may benefit from similar therapies.

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