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Eur J Prev Cardiol. 2018 Feb;25(3):298-305. doi: 10.1177/2047487317748506. Epub 2017 Dec 15.

Acute stress disorder and C-reactive protein in patients with acute myocardial infarction.

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1 Department of Biomedical Ethics, University Hospital Zurich, University of Zurich, Switzerland.
2 Department of Child and Adolescent Psychosomatic Medicine and Psychotherapy, Clinic Fontane, Mittenwalde, Germany.
3 Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
4 Department of Clinical Research, University of Bern, Switzerland.
5 Clienia Schlössli AG, Zurich, Switzerland.
6 Department of Cardiology, Clinic Barmelweid, Switzerland.
7 Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Switzerland.
8 Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
9 Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland.
10 Division of Cardiovascular Prevention, Rehabilitation and Sports Medicine, Department of Cardiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
11 Department of Psychosomatic Medicine, Clinic Barmelweid, Switzerland.


Background Myocardial infarction-triggered acute stress disorder (ASD) and subclinical inflammation associate with the development of posttraumatic stress disorder, and worsen the prognosis of myocardial infarction patients. We examined the relationship between ASD severity and C-reactive protein levels in patients with acute myocardial infarction. Methods We assessed 190 patients (median age 59 years; 83% men) with a verified myocardial infarction within 48 h of an acute coronary intervention. Circulating levels of C-reactive protein were categorized according to their prognostic risk for cardiovascular disease: 0 to <5, 5 to <10, 10 to <20, and ≥ 20 mg/l. Patients completed the ASD-Scale (ASDS) for myocardial infarction-triggered symptoms and questionnaires for demographic factors, health behaviours, cardiac-related variables and psychosocial characteristics. Results The ASDS sum score was positively associated with C-reactive protein categories in the bivariate analysis ( r = 0.20, p < 0.01). Significant relationships with C-reactive protein also emerged for dissociation ( r = 0.25, p < 0.001) and avoidance ( r = 0.19, p < 0.01), but not for arousal and re-experiencing. Similarly, C-reactive protein levels ≥ 20 mg/l versus < 20 mg/l were predicted by the ASDS sum score, and the dissociation, avoidance and arousal subscores (all p-values < 0.05) in the fully adjusted binary regression analyses. C-reactive protein levels ≥ 20 mg/l were also independently predicted by male gender, body mass index, lower education, and lower left ventricular ejection fraction and higher white blood cell count. Conclusions Higher levels of myocardial infarction-triggered ASD symptoms associate with a greater inflammatory response in patients with acute myocardial infarction independently of important covariates. The findings suggest a link between myocardial infarction-triggered ASD symptoms and a heightened acute phase response with a potential impact on cardiovascular disease prognosis.


Cardiovascular disease; inflammation; psychobiology; risk factor; trauma stress

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