title: Fear of dying and inflammation following acute coronary syndrome.
abstract: OBJECTIVE
  Many patients are afraid of dying during acute coronary syndrome (ACS), but the origins and biological correlates of these emotional responses are poorly understood. This study evaluated the prevalence of fear of dying, associations with inflammatory responses during ACS, and later heart rate variability (HRV) and cortisol secretion.
  
  
  RESULTS
  Two hundred and eight patients admitted with clinically verified ACS rated their fear of dying on interview in hospital. Plasma tumour necrosis factor (TNF)α was recorded on admission, and HRV and salivary cortisol were assessed 3 weeks later. Intense distress and fear of dying was experienced by 21.7%, with moderate levels in 66.1% patients. Fear of dying was more common in younger, lower socioeconomic status, and unmarried patients. It was positively associated with plasma TNFα on admission after controlling for sociodemographic factors, clinical risk, and pain intensity (adjusted odds = 4.67, 95% C.I. 1.66-12.65). TNFα was associated with reduced HRV 3 weeks later, adjusting for clinical and sociodemographic factors and medication (P = 0.019), while fear of dying was associated with reduced cortisol output (P = 0.004).
  
  
  CONCLUSIONS
  Intense distress and fear of dying and heightened inflammation may be related manifestations of an acute biobehavioural response to severe cardiac injury, and have implications for prognostically significant biological risk processes.
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. a.steptoe@ucl.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Molloy
authors.forename: Nadine
authors.initials: N
authors.lastname: Messerli-Bürgy
authors.forename: Anna
authors.initials: A
authors.lastname: Wikman
authors.forename: Gemma
authors.initials: G
authors.lastname: Randall
authors.forename: Linda
authors.initials: L
authors.lastname: Perkins-Porras
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology*; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000523:psychology; D001293:Attitude to Death; D005239:Fear / Q000523:psychology* / Q000528:radiation effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000097:blood / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D014409:Tumor Necrosis Factor-alpha; D006854:Hydrocortisone