title: Associations Between Psychological Constructs and Cardiac Biomarkers After Acute Coronary Syndrome.
abstract: OBJECTIVE
  Psychological constructs are associated with cardiovascular health, but the biological mechanisms mediating these relationships are unknown. We examined relationships between psychological constructs and markers of inflammation, endothelial function, and myocardial strain in a cohort of post-acute coronary syndrome (ACS) patients.
  
  
  METHODS
  Participants (N = 164) attended study visits 2 weeks and 6 months after ACS. During these visits, they completed self-report measures of depressive symptoms, anxiety, optimism, and gratitude; and blood samples were collected for measurement of biomarkers reflecting inflammation, endothelial function, and myocardial strain. Generalized estimating equations and linear regression analyses were performed to examine concurrent and prospective relationships between psychological constructs and biomarkers.
  
  
  RESULTS
  In concurrent analyses, depressive symptoms were associated with elevated markers of inflammation (interleukin-17: β = .047; 95% confidence interval [CI] = .010-.083]), endothelial dysfunction (endothelin-1: β = .020; 95% [CI] = .004-.037]), and myocardial strain (N-terminal pro-B-type natriuretic peptide: β = .045; 95% [CI] = .008-.083]), independent of age, sex, medical variables, and anxiety, whereas anxiety was not associated with these markers in multivariable adjusted models. Optimism and gratitude were associated with lower levels of markers of endothelial dysfunction (endothelin-1: gratitude: β = -.009; 95% [CI] = -.017 to - .001]; optimism: β = -.009; 95% [CI] = -.016 to - .001]; soluble intercellular adhesion molecule-1: gratitude: β = -.007; 95% [CI] = -.014 to - .000]), independent of depressive and anxiety symptoms. Psychological constructs at 2 weeks were not prospectively associated with biomarkers at 6 months.
  
  
  CONCLUSIONS
  Depressive symptoms were associated with more inflammation, myocardial strain, and endothelial dysfunction in the 6 months after ACS, whereas positive psychological constructs were linked to better endothelial function. Larger prospective studies may clarify the directionality of these relationships.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier NCT01709669.
authors.affiliation: From the Harvard Medical School (Celano, Beach, Suarez, Motiwala, Gandhi, Gaggin, Januzzi, Healy, Huffman), Boston, Massachusetts; Department of Psychiatry (Celano, Beale, Beach, Suarez, Huffman), Massachusetts General Hospital, Boston, Massachusetts, Division of Cardiology, Department of Medicine (Belcher, Gandhi, Gaggin, Januzzi), Massachusetts General Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine (Motiwala), Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Biostatistics Center (Healy), Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Celano
authors.forename: Eleanor E
authors.initials: EE
authors.lastname: Beale
authors.forename: Scott R
authors.initials: SR
authors.lastname: Beach
authors.forename: Arianna M
authors.initials: AM
authors.lastname: Belcher
authors.forename: Laura
authors.initials: L
authors.lastname: Suarez
authors.forename: Shweta R
authors.initials: SR
authors.lastname: Motiwala
authors.forename: Parul U
authors.initials: PU
authors.lastname: Gandhi
authors.forename: Hanna
authors.initials: H
authors.lastname: Gaggin
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Brian C
authors.initials: BC
authors.lastname: Healy
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000276:immunology / Q000523:psychology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003863:Depression / Q000097:blood / Q000276:immunology / Q000523:psychology; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000276:immunology / Q000523:psychology; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D020381:Interleukin-17 / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D000067656:Optimism / Q000523:psychology*; D010446:Peptide Fragments / Q000097:blood
chemical_list: D015415:Biomarkers; D019332:Endothelin-1; C515924:IL17B protein, human; D020381:Interleukin-17; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D018799:Intercellular Adhesion Molecule-1