Among young and middle-aged adults who survived a recent one myocardial infarction (MI), highly distressed individuals were twice as likely as individuals with moderate anxiety to have a significant adverse cardiovascular event (MACE) within 5 years, after adjusting for demographics and comorbidities.
Highly distressed individuals were defined as those with a high composite psychological distress score, based on their responses to the questionnaires they assessed. depression, anxiety, anger, perception of stress and Post traumatic stress disorder.
Individuals with high anxiety also had higher blood levels of two inflammatory markers: interleukin-6 (IL-6) and monocyte chemotherapeutic protein-1 (MCP-1) – in a stress test, suggesting that inflammation stress-related is involved in increased risk of MACE.
Dra. Mariana Garcia
Lead author Mariana Garcia, MD, a cardiology member at Emory University in Atlanta, Georgia, reported on these findings at a press conference and will present the study in a moderated poster session on May 16 at the virtual scientific session of the American College of Cardiology 2021.
The study suggests that cardiologists “should consider the value of psychological assessment, especially among younger patients after an MI,” he said. theheart.org | Cardiology Medscape in an interview.
They should also consider exploring treatment modalities to improve psychological distress, such as meditation, relaxation techniques, and holistic approaches, in addition to traditional medical therapy and cardiac rehabilitation after MI.
It is important to adhere to “guideline-directed secondary prevention drugs,” he added, because it is possible that anti-inflammatory drugs such as aspirin and statins “are protective against the effects of stress on daily life.”
Mental health assessment after MI
“The study reinforces the importance of assessing mental health and mental well-being in MI survivors,” said Salim S. Virani, MD, PhD, immediate chairman of the Leadership Council of the CV Disease Prevention Section, who did not participate in this investigation. , he said theheart.org | Cardiology Medscape.
“The findings are important and identify the need to work on both the process of atherosclerotic disease and mental well-being in all MI survivors,” said Virani, a professor of Cardiology and Cardiovascular Research, Baylor College of Medicine, Houston. Texas.
The study also highlights several important groups of patients with high levels of psychological distress after MI, including women, black patients, and patients with disadvantaged socioeconomic backgrounds, who may need solutions tailored to their needs while receiving long-term post-MI care.
However, more research is needed, with more extensive studies, he warned.
“Several traditional MCV risk factors also increase the risk of poor outcomes, in addition to increasing levels of inflammatory markers,” he noted, and psychological stress can lead to poor lifestyle adherence. heart disease and prescription medications after MI, especially a problem in young patients, as noted in several previous studies “
In addition, there was no control group of older MI patients in the current study, so it is possible that these findings are not restricted to young / middle-aged MI survivors only, Virani noted. Drug analysis is also needed to understand what drives the association between psychological distress and recurrent cardiovascular events.
Until more results are available in subsequent studies, “assessing the presence of psychological distress in all MI survivors (young or old) is good practice,” advises Virani.
Physicians should also work to prevent MACE in MI survivors.
“Encouraging post-MI patients to participate in comprehensive cardiac rehabilitation programs therefore becomes even more important, as it has been shown to significantly improve cardiovascular outcomes in post-MI patients and treats various components related to health, well-being, and physical and mental well-being. “
Residual risk
Little is known about psychological distress and the residual risk of future cardiovascular events in young and middle-aged patients with recent MI, Garcia said.
To investigate, the researchers identified 283 adults in the myocardial infarction and mental stress-2 (MIMS2) cohort of patients at Emory University-associated centers, who were 18 to 61 years old and had an IM during eight months earlier.
These MI survivors had a mean age of 51 years, half were women, and 64% were black.
Garcia and colleagues divided patients into thirds of mild (n = 93), moderate (93), or high (97) discomfort, based on their compound psychological distress scores, determined by the method used by Blumenthal et al.
Compared with patients with mild anxiety, those with high anxiety were more often black, female, and socioeconomically disadvantaged (low education, low income, unemployed) and were more likely to have diabetes, hypertension, or a history of smoking.
Eighty individuals developed MACE; 37% in the high anxiety group and 17% in the mild anxiety group.
Compared with those in the mild anxiety group, participants in the high anxiety group had a 2.7-fold higher risk of having MACE during follow-up.
After adjusting for age, sex, race, and education, individuals in the high-difficulty group had a similar 2.5-fold higher risk of having MACE.
However, the risk was attenuated after further adjusting for body mass index, smoking, hypertension, diabetes, dyslipidemia, and medications (HR, 1.9; 95% CI, 1, 0 – 3.8), and was no longer significant after adjusting for IL-6 and MCP-1 (FC, 1.5; 95% CI, 0.7 – 3.3).
Garcia and Virani have not revealed any relevant financial relationship.
Annual Scientific Session of the American College of Cardiology (ACC) 2021: Session 1021-05. Filed May 16, 2021.
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