title: Acute depressed mood as a trigger of acute coronary syndromes.
abstract: BACKGROUND
  Some cases of acute coronary syndrome (ACS) may be triggered by emotional states such as anger, but it is not known if acute depressed mood can act as a trigger.
  
  
  METHODS
  295 men and women with a verified ACS were studied. Depressed mood in the two hours before ACS symptom onset was compared with the same period 24 hours earlier (pair-matched analysis), and with usual levels of depressed mood, using case-crossover methods.
  
  
  RESULTS
  46 (18.2%) patients experienced depressed mood in the two hours before ACS onset. The odds of ACS following depressed mood were 2.50 (95% confidence intervals 1.05 to 6.56) in the pair-matched analysis, while the relative risk of ACS onset following depressed mood was 4.33 (95% confidence intervals 3.39 to 6.11) compared with usual levels of depressed mood. Depressed mood preceding ACS onset was more common in lower income patients (p = .032), and was associated with recent life stress, but was not related to psychiatric status.
  
  
  CONCLUSIONS
  Acute depressed mood may elicit biological responses that contribute to ACS, including vascular endothelial dysfunction, inflammatory cytokine release and platelet activation. Acute depressed mood may trigger potentially life-threatening cardiac events.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK. a.steptoe@ucl.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
authors.forename: Philip C
authors.initials: PC
authors.lastname: Strike
authors.forename: Linda
authors.initials: L
authors.lastname: Perkins-Porras
authors.forename: Jean R
authors.initials: JR
authors.lastname: McEwan
authors.forename: Daisy L
authors.initials: DL
authors.lastname: Whitehead
mesh_terms: D000208:Acute Disease; D000339:Affect / Q000502:physiology*; D000368:Aged; D000786:Anger / Q000502:physiology; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D018592:Cross-Over Studies; D003863:Depression / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007182:Income; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology