Depression predicts elevated endothelin-1 in patients with coronary artery disease.
OBJECTIVE
To examine the relationship of depression severity to circulating endothelin-1 (ET-1), which has previously been linked to plaque rupture and postacute coronary syndrome (ACS) survival. Depression carries an independent two- to four-fold increased risk of early morbidity and mortality after ACS. The pathway(s) linking depression to event-free survival remains to be determined.


METHODS
Patients with documented history of coronary artery disease (n = 101) provided a resting morning blood sample that was assayed for ET-1, and they completed the Beck Depression Inventory (BDI). ET-1 was treated as a log-transformed continuous variable (logET-1), and as a dichotomous variable using a post-ACS risk threshold previously reported (≥1.16 fmol/mL).


RESULTS
BDI score was related to logET-1 in both unadjusted and adjusted models. In addition, unadjusted and adjusted logistic regression models with dichotomous ET-1 revealed that, for each point increase in BDI score, there was approximately a 14% increased likelihood of being at or above ET-1 risk threshold. Secondary logistic regression models demonstrated a >3.5-fold likelihood of being at or above this risk threshold in association with a BDI score of ≥10.


CONCLUSIONS
Depression symptom severity predicts ET-1 elevation that has previously been linked to post-ACS survival, with the greatest risk of elevation among those patients with worse depression symptoms. This link may identify a vulnerability to triggered ACS and poorer survival associated with depression. Future research should establish whether the observed relationship of depressive symptoms to ET-1 level mediates the link between depression and survival.
Section of Cardiovascular Medicine, Yale University School of Medicine/VA Connecticut, 950 Campbell Avenue, West Haven, CT 06516, USA. mb2358@columbia.edu
Matthew M
MM
Burg
Elisabeth J
EJ
Martens
Dorothea
D
Collins
Robert
R
Soufer
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000453:epidemiology / Q000401:mortality; D000368:Aged; D003866:Depressive Disorder / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D012307:Risk Factors; D057566:Self Report; D012720:Severity of Illness Index; D016019:Survival Analysis; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D019332:Endothelin-1; D014409:Tumor Necrosis Factor-alpha