Association between posttraumatic stress disorder following myocardial infarction and liver enzyme levels: a prospective study.
BACKGROUND
Research in rodents demonstrated that psychological stress increases circulating levels of alanine transaminase, aspartate transaminase, and alkaline phosphatase reflecting liver injury. Moreover, chronic posttraumatic stress disorder and transaminases predicted coronary heart disease.


OBJECTIVE
To investigate the hypothesis that severity of posttraumatic stress disorder following myocardial infarction would prospectively relate to liver enzymes.


METHODS
Study participants were 24 patients (mean 59+/-7 years, 79% men) with an interviewer-rated diagnosis of posttraumatic stress disorder caused by an index myocardial infarction 3+/-3 months before. After a mean follow-up of 26+/-6 months, patients had a clinical interview to reassess posttraumatic stress disorder severity, a medical history, and blood collected to determine liver enzymes.


RESULTS
Total posttraumatic stress disorder symptoms assessed at study entry prospectively predicted plasma levels of alanine transaminase (r=.47, p=.031) and alkaline phosphatase (r=.57, p=.004), but not of aspartate transaminase (p=.15), controlling for follow-up duration and antidepressant use. Total posttraumatic stress disorder symptoms assessed at follow-up were associated with alanine transaminase (r=.72, p=.004), aspartate transaminase (r=.60, p=.018), and alkaline phosphatase (r=.64, p=.001) in the 16 patients who had maintained diagnostic posttraumatic stress disorder, but not in all 24 patients.


CONCLUSIONS
The severity of posttraumatic stress disorder following myocardial infarction was associated with mild increase in liver enzyme levels, suggesting that chronic psychological stress relates to hepatic damage in humans. This might help to explain the previously observed increased cardiovascular risk in chronically traumatized individuals.
von Känel
Roland
R
Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, 3010, Bern, Switzerland. roland.vonkaenel@insel.ch
Abbas
Chiara C
CC
Begré
Stefan
S
Gander
Marie-Louise
ML
Saner
Hugo
H
Schmid
Jean-Paul
JP
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000469:Alkaline Phosphatase / Q000097:blood*; D000928:Antidepressive Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008107:Liver Diseases / Q000201:enzymology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000201:enzymology / Q000523:psychology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000201:enzymology / Q000209:etiology*; D013557:Switzerland; D013997:Time Factors; D015854:Up-Regulation
D000928:Antidepressive Agents; D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase