Significance of depression and androgen deficiency in development of myocardial infarction in young males

Abstract

In the recent years, close attention has been paid to the study of depression in general medical practice, in particular, among patients with myocardial infarction (MI). Two large groups of factors, which presumably cause such a relationship, are discussed. The first group includes direct pathophysiological factors, the second – indirect, "behavioral" reactions modifying other risk factors for coronary artery disease and reduce patient adherence to prescribed therapy. The age of patients in the observed populations, as well as the predominant type of MI in patients, may have a certain influence on the results of studies. Besides, today, no unambiguous view has been formed on the question of the relationship between the androgenic status of men and the development of coronary artery disease. Among the articles analyzing the effect of androgen levels on the course of coronary heart disease, most of the studies are devoted to androgen content in the blood serum among men with stable angina, while there are relatively few studies evaluating androgen status in acute myocardial infarction and postinfarction cardiosclerosis. On the one hand, it is assumed that age-related androgen deficiency in middle-aged men with coronary heart disease may be a compensatory response to a severe general disease and can contribute to better long-term results of myocardial revascularization in them. On the other hand, it was found that men with coronary heart disease and age-related hypogonadism are characterized by more pronounced manifestations of myocardial ischemia, dysfunction of the autonomic nervous system, and more severe atherosclerosis of the coronary arteries. A review of the latest evidence is presented, summarizing clinical data on the impact of depression and androgen deficiency in the development of myocardial infarction in young men.