title: Severe depressive symptoms are associated with elevated endothelin-1 in younger patients with acute coronary syndrome.
abstract: OBJECTIVE
  To explore the relationship of depressive symptom severity to circulating endothelin (ET)-1 in younger patients with acute coronary syndrome (ACS). Younger patients report greater depressive symptom severity, which predicts poorer post-ACS prognosis. The pathways linking depression to post-ACS prognosis require further elucidation. ET-1 is a potent endogenous vasoconstrictor which has been previously linked to adverse post-ACS outcomes.
  
  
  METHODS
  The sample (n=153) included males ≤ 50 years of age and females ≤ 55 years of age who participated in a larger study. Blood samples for ET-1 assessment were collected within 2-3h of ACS admission. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) II within 2-5 days of admission. ET-1 was treated as a transformed continuous variable (ET-1T). BDI-II scores were classified into four categories using conventional thresholds demarcating mild, moderate, and severe levels of depressive symptoms. The relationship of classified BDI-II score to ET-1T was examined in simple and multivariable linear regression models.
  
  
  RESULTS
  Classified BDI-II score was related to ET-1T in both unadjusted (χ(2)=9.469, p=0.024) and multivariable (χ(2)=8.430, p=0.038) models, with ET-1T being significantly higher in patients with severe depressive symptoms than in those with mild and moderate depressive symptoms.
  
  
  CONCLUSIONS
  In this sample of younger post-ACS patients, severe depressive symptoms were associated with elevated ET-1. We acknowledge that the observed association could be eliminated by the inclusion of some unmeasured variable(s). Longitudinal research should examine whether ET-1 mediates the relationship of depressive symptoms to long-term post-ACS outcomes.
authors.affiliation: University of Texas Health Science Center at Houston, United States. Electronic address: Luba.Yammine@uth.tmc.edu.
authors.forename: Luba
authors.initials: L
authors.lastname: Yammine
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, United States.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Frazier
authors.affiliation: University of Texas Health Science Center at Houston, United States.
authors.forename: Nikhil S
authors.initials: NS
authors.lastname: Padhye
authors.affiliation: Columbia University, Center for Behavioral Cardiovascular Health, United States; Yale University, Section of Cardiovascular Medicine, United States.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
authors.affiliation: University of Texas Health Science Center at Houston, United States.
authors.forename: Janet C
authors.initials: JC
authors.lastname: Meininger
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000523:psychology*; D015415:Biomarkers / Q000097:blood; D003863:Depression / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D019332:Endothelin-1
keywords: Acute coronary syndrome; Depression; Depressive symptoms; Endothelin; Myocardial infarction; Younger patients