C-reactive protein and fibrinogen in non-obstructive coronary artery disease as related to depressive symptoms and anxiety: Findings from the TweeSteden Mild Stenosis Study (TWIST)

Mommersteeg, Paula M.C.; Meeuwis, Stefanie H; Denollet, Johan; Widdershoven, Jos; Aarnoudse, Wilbert; Westerhuis, Bert L.W.J.J.M.; Kop, Willem J.

doi:10.1016/j.jpsychores.2014.09.020

Cited by 11 publications

(18 citation statements)

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“…However, the use of statins (and possibly beta-blockers and anti-depressants) may have reduced the inflammatory state [45–47] and thereby obscured the relation between CRP and depressive symptoms. In our study, however, an even higher proportion of patients used statins (87.7%) than in these latter studies; moreover, our study sample was larger than that of earlier studies [20, 23, 44]. Our findings are in line with the results of a large meta-analysis which also found that higher CRP levels were associated with more depressive symptoms in healthy individuals [19].…”

Section: Discussionsupporting

confidence: 88%

“…Earlier studies in CHD patients found no association between CRP levels and depressive symptoms [20, 23, 44]. However, the use of statins (and possibly beta-blockers and anti-depressants) may have reduced the inflammatory state [45–47] and thereby obscured the relation between CRP and depressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Among three studies that included from 71 to almost 1000 CHD patients [20–22], only the smaller study found a significantly increased CRP level in depressed CHD patients [22], whereas the two larger studies found no significant relation [20, 21]. In another study, when examining the linear relation between increasing CRP level and depressive symptoms, higher levels of CRP showed a significant association with more depressive symptoms; however, this association did not persist after adjustment for covariates [23]. …”

Section: Introductionmentioning

confidence: 99%

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Kidney dysfunction, systemic inflammation and mental well-being in elderly post-myocardial infarction patients

et al. 2017

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BackgroundThe aim was to investigate whether mild kidney dysfunction and low-grade inflammation in post-myocardial infarction patients are independently associated with markers of mental well-being (i.e. depressive and apathy symptoms, and dispositional optimism).MethodsIn post-myocardial infarction patients, kidney function was assessed by estimated glomerular filtration rate (eGFR) calculated from the combined CKD-EPI formula based on serum levels of both creatinine and cystatine C. Systemic inflammation was assessed using high sensitivity C-reactive protein (hs-CRP) levels. The 15-item Geriatric Depression Scale (GDS-15), the 3-item apathy subscale and the 4-item optimism questionnaire (4Q) were used to measure mental well-being and were analyzed using linear multivariable regression analysis.ResultsOf the 2355 patients, mean age was 72.3 (range 63–84) years and 80.1% were men. After multivariable adjustment, a poorer kidney function was associated with more depressive symptoms (β = -0.084, p < 0.001), more apathy symptoms (β = -0.101, p < 0.001), and less dispositional optimism (β = 0.072, p = 0.002). Moreover, higher levels of hs-CRP were associated with more depressive symptoms (β = 0.051, p = 0.013), more apathy symptoms (β = 0.083, p < 0.001) and less dispositional optimism (β = -0.047 p = 0.024). Apathy showed the strongest independent relation with both low eGFR and high hs-CRP.ConclusionsIn post-myocardial infarction patients, impaired kidney function and systemic inflammation showed a stronger association with apathy than with depressive symptoms and dispositional optimism.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Kidney dysfunction, systemic inflammation and mental well-being in elderly post-myocardial infarction patients

et al. 2017

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“…To date, the literature examining the relationships between anxiety and inflammation has been mixed (19–23), and the relationship between anxiety and cardiac prognosis (29, 55) appears weaker than that of depression (12, 55, 56). Our findings suggest that anxiety’s relationship to cardiovascular health may be explained in part by depressive symptoms, which have been more clearly associated with both inflammatory markers and cardiac prognosis in patients with heart disease (12, 56).…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have found that depression is associated with abnormal levels of inflammatory cytokines and other established markers of poor cardiac prognosis (15–18), and anxiety has been linked to elevated levels of inflammatory markers in some studies (19, 20) but not others (21–23). On the other hand, smaller numbers of studies have found that positive constructs, such as optimism, may be associated with improved levels of cardiac biomarkers (14, 24), and gratitude has been associated with increased parasympathetic activity (25).…”

Section: Introductionmentioning

confidence: 97%

Associations Between Psychological Constructs and Cardiac Biomarkers After Acute Coronary Syndrome

et al. 2017

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Objective Psychological constructs are associated with cardiovascular health, but the biological mechanisms mediating these relationships are unknown. We examined relationships between psychological constructs and markers of inflammation, endothelial function, and myocardial strain in a cohort of post-acute coronary syndrome (ACS) patients. Methods Participants (N=164) attended study visits 2 weeks and 6 months post-ACS. During these visits, they completed self-report measures of depressive symptoms, anxiety, optimism, and gratitude, and blood samples were collected for measurement of biomarkers reflecting inflammation, endothelial function, and myocardial strain. Generalized estimating equations and linear regression analyses were performed to examine concurrent and prospective relationships between psychological constructs and biomarkers. Results In concurrent analyses, depressive symptoms were associated with elevated markers of inflammation (interleukin-17: β=.047, 95% confidence interval [.010, .083]), endothelial dysfunction (endothelin-1: β=.020, [.004, .037]), and myocardial strain (N-terminal pro-B-type natriuretic peptide: β=.045, [.008, .083]), independent of age, sex, medical variables, and anxiety, while anxiety was not associated with these markers in multivariable adjusted models. Optimism and gratitude were associated with lower levels of markers of endothelial dysfunction (endothelin-1: gratitude: β=−.009, [−.017, −.001]; optimism: β=−.009, [−.016, −.001]; soluble intercellular adhesion molecule-1: gratitude: β=−.007, [−.014, −.000]), independent of depressive and anxiety symptoms. Psychological constructs at 2 weeks were not prospectively associated with biomarkers at 6 months. Conclusions Depressive symptoms were associated with more inflammation, myocardial strain, and endothelial dysfunction in the 6 months post-ACS, while positive psychological constructs were linked to better endothelial function. Larger, prospective studies may clarify the directionality of these relationships.

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Cancer comorbidity in patients with non-obstructive coronary artery disease: Depressive symptoms related to C-reactive protein

Schoormans

Widdershoven

Mommersteeg

2020

Brain, Behavior, & Immunity - Health

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Background Based on guidelines for cardiovascular risk assessment among non-cancer populations, depression and anxiety can be seen as risk factors for CVD, on top of cardiotoxic cancer treatment and traditional CVD risk factors among cancer survivors. Increased inflammation can be a shared potential pathophysiological mechanism, as higher levels of inflammation (like C-reactive protein, CRP) are known associates of depression and anxiety. In turn, increased inflammation is involved in the pathogenesis of CVDs. Furthermore, both cancer and cancer treatment including chemotherapy and radiation can lead to elevated levels of inflammation. We will therefore examine whether the relation between depression and anxiety with inflammatory markers among patients with either CVD or cancer is different from those with both conditions. Method The TweeSteden Mild Stenosis (TWIST) study among patients with non-obstructive coronary artery disease (NOCAD, luminal narrowing <60%), a type of ischemic heart disease, previously reported a significant association between depressive symptoms and increased inflammation (measured by high-sensitive (hs)CRP). Of the included NOCAD-patients, 6% had a history of cancer. The TWIST patient sample was therefore used to explore whether the association between depression and elevated inflammation (hsCRP) was similar for NOCAD-patients with and without a history of cancer. Results The association between depressive symptoms and increased hsCRP levels is stronger among NOCAD-patients with a history of cancer than among NOCAD-patients without a history of cancer. Furthermore, whereas this relation is mediated by lifestyle factors among NOCAD-patients without cancer, the association remained significant after adjusting for BMI, smoking, and physical activity among NOCAD-patients with a history of cancer. Conclusion The stronger association between depression and hsCRP among NOCAD-patients with a history of cancer indicates that there may be an additive or synergistic effect of having NOCAD and cancer for general inflammation and possibly depression.

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C-reactive protein and fibrinogen in non-obstructive coronary artery disease as related to depressive symptoms and anxiety: Findings from the TweeSteden Mild Stenosis Study (TWIST)

Cited by 11 publications

References 28 publications

Kidney dysfunction, systemic inflammation and mental well-being in elderly post-myocardial infarction patients

Kidney dysfunction, systemic inflammation and mental well-being in elderly post-myocardial infarction patients

Associations Between Psychological Constructs and Cardiac Biomarkers After Acute Coronary Syndrome

Cancer comorbidity in patients with non-obstructive coronary artery disease: Depressive symptoms related to C-reactive protein

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