La relación de la depresión y el estrés con el infarto del miocardio: un estudio de casos y controles

Publicado

2015-07-01

Association of depression and stress in acute myocardial infarction: a case-control study

La relación de la depresión y el estrés con el infarto del miocardio: un estudio de casos y controles

Palabras clave:

Depression, Stress, Infarction, Cardiovascular Disease, Risk factors, Epidemiology. (en)
Depresión, Infarto del miocardio, Factores de riesgo, Epidemiología (es)

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Autores/as

Patricia RM Goldfeld Department of Cardiology, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Luciana S Soares Scholarship of Scientific Initiation, Department of Cardiology, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Waldomiro C Manfroi Department of Cardiology. Medical School, Universidade Federal do Rio Grande do Sul. Porto Alegre, Brazil.

Resumen (en)
Resumen (es)

Background. Psychosocial factors have been reported to be independently associated with coronary artery disease (CAD). However the stress variable is still sub detailed and there are few studies that used coronary angiography (CA) to assess CAD.

Objectives. To compare levels of depression, stress and stressful life events in three groups of individuals: post-MI (Myocardial Infarction) patients; patients presenting symptoms and no previous MI who underwent cardiac catheterization and had non-significant obstructive CAD and individuals with no symptoms of cardiac disease or others diseases.

Methods. We conducted a case-control study, with two cases groups and one control group. The study included 105 patients with recent Myocardial Infarction (MI group), 101 patients with cardiac symptoms and normal CA (CS group), and 100 patients without symptoms of disease (NS group). Multivariate logistic regression was used to assess stress and vital events with an Odds Ratio of 95% confidence interval (CI), controlling for age, sex, education level, income, social support group, Body Mass Index (BMI), sedentary lifestyle and family history of MI or sudden death.

Results. MI patients group showed depression with an OR= 4.47(95% CI, 2:36 to 8:46, p<.001), and stress OR= 5.37(95%CI, 2.94–9.78, p<.001) whereas CS group showed depression: OR= 6.95(95%CI, 3.64–13.28, p<.001) and stress: OR=9.18 (95%CI, 4.73–17.82, p<.001) compared to patients without symptoms. After adjusting the groups for the following risk factors: age, sex, education, income, social support, obesity, sedentary lifestyle, family history of MI or sudden death, the OR showed the following variation: in the MI group, depression OR=2.51 (95%CI, 1:05 to 5:98, p=.038), stress, OR=8.76(95%CI, 3:48 to 22:01, p<.001), while the CS group showed: depression OR=3.25(95%CI, 1.40-7.55,p<01) and stress OR=12.24 (95%, CI, 4.81-31.14, p<.001). The raised effect of variable stress after adjustment was promoted by age, sex and physical inactivity variables, and did not affect the significance level (p<.001).

Conclusions. This study has demonstrated that subjects with cardiac symptoms without overt CAD show similar depression and/or stress levels than post-MI patients, and that post-MI patients and CS patients experience more stress and depression than control patients, even when they adjusted in terms of age, sex, education level, family income, social support, obesity, sedentary lifestyle and family history of MI and / or sudden death.

Antecedentes. Factores psicosociales han demostrado asociación independiente con la enfermedad arterial coronaria (EAC); sin embargo, la variable estrés sigue siendo sub detallada y hay pocos estudios que utilizaron la angiografía coronaria (CA) para evaluar EAC.

Objetivos. Comparar los niveles de depresión, el estrés y los acontecimientos vitales estresantes en tres grupos de personas: en pacientes post-IM (infarto de miocardio), en pacientes que presentan síntomas cardiacos y cateterismo cardíaco normal y en individuos sin síntomas de enfermedades cardíacas.

Métodos. Se realizó un estudio de casos y controles —dos grupos de casos y un grupo control—. El estudio incluyó a 105 pacientes con infarto de miocardio reciente (grupo MI), 101 pacientes con síntomas cardíacos y CA normal (grupo CS), y 100 pacientes sin síntomas de la enfermedad (grupo NS). Se utilizó multivariante de regresión logística para evaluar el estrés y los acontecimientos vitales con una odds ratio de intervalo de confianza del 95% (IC), controlando por edad, sexo, nivel educativo, ingresos, grupo de apoyo social, el indice de masa corporal (IMC), el sedentarismo y los antecedentes familiares de infarto de miocardio o muerte súbita.

Resultados. Los pacientes del grupo MI mostraron depresión con una OR=4.47 (IC del 95%, 02:36-08:46, p<0.001), y el estrés OR=5.37 (IC 95%, 2.94-9.78; p<0,001) mientras que el grupo CS mostró depresión OR=6.95 (95% CI, 3.64 a 13.28, p<0.001) y el estrés OR=9.18 (95% CI, 4.73 a 17.82, p<0.001) en comparación con los pacientes sin síntomas. Después de ajustar por factores de riesgo: edad, sexo, educación, ingresos, apoyo social, obesidad, sedentarismo, antecedentes familiares de infarto de miocardio o muerte súbita, el OR mostró la siguiente variación: en el grupo de MI, depresión OR=2.51 (IC del 95%, 1:05 a 5:98, p=0.038), el estrés, OR=8.76 (IC del 95%, 3:48–22:01, p<0.001), y CS grupo, depresión OR=3.25 (95% CI, 1.40 a 7.55, p<01) y el estrés OR=12.24 (95%, IC, 4.81 a 31.14, p<0.001). El efecto de elevación de la variable estrés después del ajuste fue promovida por las variables de edad, sexo e inactividad física, y no afectó el nivel de significación (p<0.001).

Conclusiones. Este estudio ha demostrado que los sujetos con síntomas cardíacos sin EAC presentan similares niveles de depresión y / o estrés a los de los pacientes post-IM. También se demostró que los pacientes post-IM y los pacientes CS tienen más estrés y depresión que los controles, incluso cuando se ajustan por edad, sexo, nivel de educación, ingreso familiar, apoyo social, obesidad, sedentarismo y antecedentes familiares de infarto de miocardio y / o muerte súbita.

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