Broken heart: Broken mind.
نویسندگان
چکیده
The increased frequency of sudden cardiac death after earthquakes and bombings has long proposed that emotional distress plays a role in acute coronary syndromes and arrhythmias. Since the 1960s, several controlled, prospective, epidemiological studies have reported emotional distress as a major risk factor for the onset and worsening of coronary heart disease (CHD) [1]. The Interheart study, a case control trial of around 29,000 participants in 52 countries, has found that psychosocial risk factors, including stress, depression, and low generalized locus of control, are responsible for 32.5% of the population attributable risk for myocardial infarction (MI). This is independent of, and only slightly less than, the population attributable risk for lifetime smoking (35.7%) and greater than that for hypertension (17.9%) or obesity (20.0%) [2]. Also, depression has repeatedly been found in many studies to predict earlyonset CHD; increased post-MI mortality (1.5–5.07 times risk); and increased cardiac symptoms such as chest pain and fatigue [3]. Based on the abovementioned data which provides compelling evidence that depression is associated with a worse outcome in CHD population, there is a need to examine mediators that explain this association. A number of behavioral and biological factors were implicated including lack of exercise, diabetic dyscontrol, smoking, medication noncompliance, HPA axis dysregulation, platelet aggregation, vascular inflammation, endothelial dysfunction, decreased heart rate variability, autonomic instability, and hypertension. One of the clinical mediators is severity and the treatment-resistant quality of depression. Recently, a follow-up analysis of the SADHART trial found patients who failed to recover from depression after a CHD event or scored greater than 18 on the Hamilton Depression Rating (HAM-D) scale in the first 2 weeks post MI to have doubled the mortality rate compared to those who return to psychological health even 7 years after the initial cardiac event [4]. Furthermore, researchers studied different depressive symptoms and psychosocial constructs as a predictive factor of hypertension and CHD. Chida and Steptoe [5], in their major meta-analysis of 80,000 individuals, demonstrated that anger and hostility were associated with a 19% increase in CHD events in healthy individuals especially
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ورودعنوان ژورنال:
- Journal of psychosomatic research
دوره 67 4 شماره
صفحات -
تاریخ انتشار 2009