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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- Manual for the Beck Depression Inventory-II. Psychological Corporation, San Antonio, TX1996
- Stress and the inflammatory response: A review of neurogenic inflammation.Brain Behav Immun. 2002; 16: 622-653
- Stress, inflammation and cardiovascular disease.J Psychosom Res. 2002; 52: 1-23
- Effects of exercise training on older patients with major depression.Arch Intern Med. 1999; 159: 2349-2356
- Protocol for the bypass angioplasty revascularization investigation.Circulation. 1991; 84: V1-V27
- Cytokines and psychopathology: Lessons from interferon-alpha.Biol Psychiatry. 2004; 56: 819-824
- Effects of antidepressants on cytokine production and actions.Brain Behav Immun. 2002; 16: 569-574
- Association between depression and elevated C-reactive protein.Psychosom Med. 2003; 65: 347-356
- Behavioral effects of cytokines: An insight into mechanisms of sickness behavior.Methods Neurosci. 1993; 17: 130-150
- Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: The Prospective Epidemiological Study of Myocardial Infarction (PRIME).Circulation. 2005; 111: 2299-2305
- Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: A randomized trial.JAMA. 2004; 292: 1440-1446
- Structured Clinical Interview for DSM-IV Axis I Disorders. Biometrics Research Department, New York State Psychiatric Institute, New York, NY1996
- Depression and C-reactive protein in US adults: Data from the Third National Health and Nutrition Examination Survey.Arch Intern Med. 2004; 164: 1010-1014
- Acute myocardial infarction induces hypothalamic cytokine synthesis.Am J Physiol Heart Circ Physiol. 2004; 286: H2264-H2271
- Gender, depression and one year prognosis after myocardial infarction.Psychosom Med. 1999; 61: 26-37
- Does treating post-myocardial infarction depression reduce medical mortality?.Arch Gen Psychiatry. 2005; 62: 711-712
- Effect of hydroxymethyl glutaryl coenzyme a reductase inhibitor therapy on high sensitive C-reactive protein levels.Circulation. 2002; 103: 1933-1935
- To Your Health. Oxford University Press, New York2005
- C-reactive protein, depressed mood, and the prediction of coronary heart disease in initially healthy men: Results from the MONICA-KORA Augsburg Cohort Study 1984–1998.Eur Heart J. 2005; 26: 2537-2542
- The association between major depression and levels of soluble intercellular adhesion molecule 1, interleukin-6, and C-reactive protein in patients with recent acute coronary syndromes.Am J Psychiatry. 2004; 161: 271-277
- Depression as a risk factor for coronary artery disease: Evidence, mechanisms, and treatment.Psychosom Med. 2004; 66: 305-315
- The association between C-reactive protein levels and depression: Results from the northern Finland 1966 birth cohort study.Biol Psychiatry. 2006; 60: 825-830
- Markers of inflammation.in: Théroux P. Acute Coronary Syndrome. Saunders, Philadelphia, PA2003: 209-225
- Life stress, mood disturbance, and elevated interleukin-6 in healthy older women.J Gerontol. 1999; 54A: M434-M439
- Pathways linking depression, adiposity, and inflammatory markers in healthy young adults.Brain Behav Immun. 2003; 17: 276-285
- Clinical depression and inflammatory risk markers for coronary heart disease.Am J Cardiol. 2002; 90: 1279-1283
- Inflammatory markers and sleep disturbance in major depression.Psychosom Med. 2005; 67: 187-194
- Inflammatory markers and depressed mood in older persons: Results from the Health, Aging and Body Composition study.Biol Psychiatry. 2003; 54: 566-572
- Depression and cardiac mortality.Arch Gen Psychiatry. 2001; 58: 221-227
- Cytokines and adhesion molecules in the course of acute myocardial infarction.Clin Chim Acta. 1999; 280: 127-134
- C-reactive protein levels and outcomes after statin therapy.N Engl J Med. 2005; 352: 20-28
- Prognostic modelling with logistic regression analysis: A comparison of selection and estimation methods in small data sets.Stat Med. 2000; 19: 1059-1079
- Apoptosis detected in the amygdala following myocardial infarction in the rat.Biol Psychiatry. 2006; 59: 430-433
Published online: January 09, 2007
Accepted: September 29, 2006
Received in revised form: September 13, 2006
Received: July 13, 2006
© 2007 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.