Association of depression and stress in acute myocardial infarction: a case-control study

Background: Psychosocial factors have been reported to be independently associated with coronary artery disease (CAD). However, the stress variable is still sub detailed and there are few studies that used coronary angiography (CA) to assess CAD. Objectives: To compare levels of depression, stress and stressful life events in three groups of individuals: post-MI (Myocardial Infarction) patients; patients presenting symptoms and no previous MI, who underwent cardiac catheterization and had non-significant obstructive CAD and individuals with no symptoms of cardiac disease or others diseases. Methods: We conducted a case-control study, with two cases groups and one control group. The study included 105 patients with recent Myocardial Infarction (MI group), 101 patients with cardiac symptoms and normal CA (CS group), and 100 patients without symptoms of disease (NS group). Multivariate logistic regression was used to assess, stress and vital events, with an Odds Ratio of 95% confidence interval (CI), controlling for age, sex, education level, income, social support group, Body Mass Index (BMI), sedentary lifestyle and family history of MI or sudden death. Results: MI patients group showed depression with an OR= 4.47(95% CI, 2:36 to 8:46, p<.001), and stress OR= 5.37(95%CI, 2.94-9.78, p <.001) whereas CS group showed depression: OR= 6.95(95%CI, 3.64-13.28, p <.001) and stress: OR = 9.18 (95%CI, 4.73-17.82, p <.001) compared to patients without symptoms. After adjusting for risk factors: age, sex, education, income, social support, obesity, sedentary lifestyle, family history of MI or sudden death, the OR showed the following variation: in the MI group, depression OR= 2.51 (95%CI, 1:05 to 5:98, p = .038), stress, OR= 8.76(95%CI, 3:48 to 22:01, p <.001), and CS group, depression OR= 3.25(95%CI, 1.40-7.55,p <01) and stress OR= 12.24 (95%, CI, 4.81-31.14, p <.001). The raised effect of variable stress after adjustment was promoted by the age, sex and physical inactivity variables, and did not affect the significance level (p <.001). Conclusions: This study has demonstrated that subjects with cardiac symptoms without overt CAD, present similar depression and/or stress levels than post-MI patients. And also, post-MI patients and CS patients have more stress and depression than controls, even when adjusted for age, sex, education level, family income, social support, obesity, sedentary lifestyle and family history of MI and / or sudden death