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Orlando,Fl -ASSESSMENT OF A DEPRESSIVE MOOD STATE IMPROVES THE POWER OF C-REACTIVE PROTEIN TO PREDICT A FUTURE CORONARY EVENT IN APPARENTLY HEALTHY MIDDLE AGED MEN! | |
| Contact: Prof. K.H. Ladwig, GSF National Research Center for Environment and Health
Munich - Neuherberg (Germany)
Email: Ladwig@gsf.de Embargoed until: March 5, 2004 |
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Many myocardial infarctions often occur among people with risk factor values who otherwise appear to be at low clinic risk. In an attempt to better predict future coronary events, large scale epidemiological studies have explored a series of novel risk factors for coronary disease. Among these, inflammatory markers, such as C-reactive protein (CRP) have received the most attention. Now it is widely accepted that even low levels of elevated CRP may suggest risk for future coronary events in apparently healthy persons long before the onset of a clinical disease. Increased values of CRP may reflect tissue damage and inflammation not only in the arteries but anywhere in the body. These elevated levels may be induced by metabolic, infective, immunologic, or other processes. Indeed, not all triggers for increased CRP production have been identified so far. However, there is growing evidence that CRP also raises under chronic stress conditions such as a depressive disease or even under a persistent depressive mood. Interestingly, depression itself has been accused to be a powerful predictor of a future coronary event. Applying data from one of Europe's most extended population based studies - the MONICA/ KORA Cohort Study - in an urban environment in southern Germany, Ladwig and co-workers investigated whether a depressed and exhausted mood augments the capacity of CRP to predict a future coronary event. Results of the study were presented for the first time at the American Psychosomatic Society Annual Meeting, held March 3-7 in Orlando, FL. More than 3,000 initially healthy male subjects aged 25 to 74 years were thoroughly examined and then followed under normal living conditions for an average of seven years. During this observational period, a total of 165 coronary events occurred. Roughly one third of these study participants was at low, moderate or high risk in terms of CRP categories. Also, two thirds of participants exhibited no symptoms of a depressed mood while one third was considered as being depressed or exhausted. The study confirmed that both conditions independently predicted a future coronary event even after controlling for a broad range of other risk factors - such as smoking habits, hyperlipidemia, hypertension and physical inactivity. "The finding of a significant interaction between CRP and depressive mood encouraged us to look separately at the effect of CRP in the group with low and high depression" said Ladwig. The results showed that CRP in the low-depression group lost its predictive value while in the depression group, CRP (in the highest level) mounted considerably to an odds of 2.70! These findings demonstrate synergism in the predictive value of depressive symptoms and CRP as predictors of future coronary events in apparently healthy male people. In particular, CRP may not be a sensitive risk factor in male subjects who are not affected by a depressived and exhausted mood. These findings underline that CRP can be interpreted only when there is full knowledge of the clinical state of the patient, as ascertained by a thorough medical examination including the patients' affective state. | |
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Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society, published bimonthly. For information about the journal, contact Vicki White, Managing Editor for Manuscript Production,
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