Inflammatory Protein Levels and Depression Screening After Coronary Stenting Predict Major Adverse Coronary Events

Abstract

Background Traditional risk factors cannot account for the majority of future major adverse coronary events (MACE) in patients diagnosed with heart disease. We examined levels of inflammatory proteins to be possible predictors of future MACE and physiological and psychological factors that initiate temporal increases in inflammatory protein levels. Methods Peripheral blood samples and depression data were collected 4 to 12 hr after elective coronary stent insertion in 490 patients. Depression screening was assessed by a single-question screening tool. Predictive modeling for future MACE was performed by using survival analysis, with time from the index event (placement of the stent) to future MACE as the dependent variable. Results Patients with high-sensitivity c-reactive protein (hsCRP) in the second and third quartiles were 3 and 2.5 times more likely to have a MACE than patients with hsCRP in the first quartile, respectively. As levels of vascular cell adhesion molecule and monocyte chemoattractant protein-1 increased, so did the risk of future MACE. Patients who screened positive for depression were approximately 2 times more likely to have a MACE within 24 months after stent placement than were patients who did not screen positive. Conclusions Our results suggest that hsCRP, vascular cell adhesion molecule, and monocyte chemoattractant protein-1 levels, measured after coronary stent insertion in patients with coronary heart disease, are prognostic of future MACE. Furthermore, positive depression screening is an independent predictor of future MACE.

The role of inflammatory markers in explaining the association between depression and cardiovascular hospitalisations

“…However, some studies indicate there is a synergy between inflammation and depression, for instance observing that CRP is only a key predictor of cardiovascular events in participants with depressive symptoms compared to those without (Ladwig et al, 2005), or observing the strongest association between depression and coronary heart disease for participants in the lowest quartile of CRP (Surtees et al, 2008a). Studies conducted in samples with existing cardiovascular disease draw similar conclusions of an independent relationship between inflammatory markers, depression and cardiovascular events (Frazier et al, 2009;Rallidis et al, 2011;Vaccarino et al, 2007;Whooley et al, 2008). However, one study indicated that participants with both low depressive symptoms and low CRP had low risk of further events, whereas participants with either high CRP or depressive symptoms were at similarly increased risk of events (Frasure- Smith et al, 2007).…”

Berberine ameliorates inflammation in patients with acute coronary syndrome following percutaneous coronary intervention

“…Inflammation is not only central to the pathogenesis of atherosclerosis and plaque instability, but also contributes to adverse clinical outcomes related to PCI . A growing body of clinical research has demonstrated that circulating inflammatory markers (VCAM‐1, ICAM‐1, MCP‐1, IL‐6 and CRP) are strong predictors for mortality and future cardiovascular events in many clinical settings, including ACS patients following PCI . Previous studies have reported that berberine can inhibit the expression of tumour necrosis factor‐α, MCP‐1, IL‐6 and cyclo‐oxygenase‐2 in stimulated macrophages by activating AMP kinase or inhibiting extracellular signal‐regulating kinase (ERK) 1/2 .…”

Using a Single Screening Question for Depressive Symptoms in Patients With Acute Coronary Syndrome

“…1,2 Studies indicate that the presence of depressive symptoms is a major independent risk factor for future major adverse coronary events (MACE) in patients with ACS contributing to decreased quality of life and increased health care costs. 3-5 Results from a 2004 meta-analysis assessing the link between depression and ACS and subsequent MACE indicate a consistent association between post-ACS depression and increased future MACE from either all-cause or cardiac mortality independent of severity of cardiac disease. 5 Several potential mechanisms linking the presence of depressive symptoms and poor cardiovascular outcomes have been hypothesized in depressed patients.…”

“…Potential mechanisms include unhealthy lifestyle behaviors (for example cigarette smoking and lack of exercise) and poor medical compliance (for example poor cardiac rehabilitation attendance and poor medication adherence), as well as potential physiological changes, including increases in sympathetic nervous system activity and increases in inflammatory and platelet responses. 3,5-7 Our team has previously reported that a single question “Have you ever felt sad or depressed much of the time in the past year?” is significantly associated with future MACE in patients with coronary artery disease (CAD). 3 Despite the clinical significance of the presence of depressive symptoms on adverse cardiac outcomes, screening for depressive symptoms is not a part of routine care for ACS patients in the acute care setting.…”

“…3,5-7 Our team has previously reported that a single question “Have you ever felt sad or depressed much of the time in the past year?” is significantly associated with future MACE in patients with coronary artery disease (CAD). 3 Despite the clinical significance of the presence of depressive symptoms on adverse cardiac outcomes, screening for depressive symptoms is not a part of routine care for ACS patients in the acute care setting. Potential reasons for this discrepancy are limited provider awareness and level of comfort with depressive symptom screening, provider time constraints, the stigma of depression, limitations in reimbursement for psychiatric patient services, and the lack of consensus on what screening method to use with the ACS population.…”