title: Depression and disease severity in patients with premature acute coronary syndrome.
abstract: OBJECTIVE
  The association between depression and cardiovascular disease severity in younger patients has not been assessed, and sex differences are unknown. We assessed whether major depression and depressive symptoms were associated with worse cardiovascular disease severity in patients with premature acute coronary syndrome, and we assessed sex differences in these relationships.
  
  
  METHODS
  We enrolled 1023 patients (aged ≤ 55 years) hospitalized with acute coronary syndrome from 26 centers in Canada, the United States, and Switzerland, through the GENdEr and Sex determInantS of cardiovascular disease: From bench to beyond-Premature Acute Coronary Syndrome study. Left ventricular ejection fraction, Killip class, cardiac troponin I, and Global Registry of Acute Coronary Events score data were collected through chart review.
  
  
  RESULTS
  The sample comprised 248 patients with major depression and 302 women. In univariate analyses, major depression was associated with a lower likelihood of having an abnormal left ventricular ejection fraction (odds ratio, 0.70; 95% confidence interval, 0.51-0.97; P = .03) and lower troponin I levels (estimate, -4.04; 95% confidence interval, -8.01 to -0.06; P = .05). After adjustment for sociodemographic and clinical characteristics, neither major depression nor depressive symptoms were associated with disease severity indices, and there were no sex differences.
  
  
  CONCLUSIONS
  The increased risk of adverse events in depressed patients with premature acute coronary syndrome is not explained by disease severity.
authors.affiliation: Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Pelletier
authors.affiliation: University of Quebec in Montreal and Research Centre, Hôpital du Sacré-Coeur de Montréal, Québec, Canada.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.affiliation: Concordia University and Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.affiliation: Department of Medicine and Research Institute, McGill University Health Center, Montréal, Québec, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Thanassoulis
authors.affiliation: Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Khan
authors.affiliation: Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; Division of Internal Medicine, McGill University, Montréal, Québec, Canada. Electronic address: louise.pilote@mcgill.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002170:Canada; D003863:Depression / Q000175:diagnosis / Q000209:etiology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D012720:Severity of Illness Index; D013318:Stroke Volume; D013557:Switzerland; D019210:Troponin I / Q000097:blood; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Acute coronary syndrome; Depression; Disease severity; Epidemiology; Women