GENDER-RELATED CHARACTERISTICS OF AFFECTIVE DISORDERS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

The study objective is to investigate characteristics of mixed anxiety-depressive disorders (MADD) and the level of subjective self-control  in relation to health (SSCh), as well as the effect of affective disorder severity on clinical course and prognosis of the disease in men and women with acute myocardial infarction (AMI).

Materials and methods. The study included 124 patients with AMI aged between 30 and 85 years (mean age 58.6  ±  12.1 years), who were divided into 2 groups: the 1st group contained 88 (71 %) men, the 2nd group – 36 (29 %) women.

Results. Per the screening test, MADD was more frequently diagnosed in the female group (91.7 %) compared to the male group (56.8 %),  р <0.001. Absence of anxiety symptoms per the Hospital Anxiety and Depression Scale (HADS) was more frequently observed in the male group (77.3 % vs. 52.8 %, р <0.01; relative risk (RR) 1.46; 95 % confidence interval (CI) 1.05–2.03), and significant level of anxiety per HADS was more frequently diagnosed in the female group (4.5 % vs. 27.8 %, р <0.01; RR 0.16; 95 % CI 0.05–0.48). Absence of depression symptoms per HADS was more frequently observed in the male group (68.2 % vs. 30.6 %, р <0.01; RR 2.23; 95 % CI 1.33–3.72), and moderate (14.8 % vs. 33.3 %, р <0.05; RR 0.44; 95 % CI 0.22–0.87) and severe (17.0 % vs. 36.1 %, р <0.05; RR 0.47; 95 % CI 0.25– 0.88) levels of depression per HADS were more common in the female group. Absence of depression symptoms per the Beck Depression Inventory (BDI) was more frequently observed in the male group (42.1 % vs. 11.1 % women, р <0.01; RR 3.78; 95 % CI 1.45–9.84). In the female group, moderate (27.8 % vs. 10.2 %, р <0.05; RR 0.36; 95 % CI 0.16–0.83) and severe (13.9 % vs. 3.4 %, р <0.05; RR 0.24; 95 % CI 0.06–0.97) levels of depression per this scale were more common than in the male group. Left ventricular ejection fraction was lower  in the female group (41.4 ± 11.4 %) compared to the male group (45.8 ± 10.3 %), р <0.05. Mortality was higher in the female group compared to the male group: overall (19.4 % vs. 5.7 %, р <0.05), hospital (8.3 % vs. 1.1 %, р <0.05), and post-hospital (11.1 % vs. 4.5 %,  р >0.05) mortality, respectively. 

Conclusion. Psychometric tests have shown higher rate and severity of MADD in the female group compared to the male group. In the female group, left ventricular ejection fraction was significantly lower than in the male group, and overall and hospital mortality was higher. 

1. Здоровье населения и деятельность организаций здравоохранения Кыргызской Республики в 2015 году. РМИЦ, Бишкек, 2016. [The health of the population and activities of healthcare organizations of the Kyrgyz Republic in 2015. RMIC, Bishkek, 2016. (In Russ.)].

2. Mandelzweig L., Battler A., Boyko V. et al. Euro Heart Survey Investigators. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and Mediterranean Basin in 2004. Eur Heart J 2006;27(19):2285– 93. DOI: 10.1093/eurheartj/ehl196. PMID: 16908490.

3. Bucholz E.M., Butala N.M., Rathore S.S. et al. Sex differences in long-term mortality after myocardial infarction: a systematic review. Circulation 2014;130(9):757–67. DOI: 10.1161/CIRCULATIONAHA.114.009480.

4. Wassertheil-Smoller S., Shumaker S., Gskene J. et al. Depression and cardiovascular sequelae in postmenopausal women. The Women’s Health Iniciative (WHI). Arch Intern Med 2004;164(3):289–98. DOI: 10.1001/archinte.164.3.289. PMID: 14769624.

5. Kim K.A., Kim J.S., Kim M.S. Predictors of coronary heart disease risk in healthy men and women. Taehan Kanho Haknoe Chi 2007;37(7):1039–48. PMID: 18182865.

6. Mehta L.S., Beckie T.M., DeVon H.A. et al. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016;133(9):916–47. DOI: 10.1161/CIR.0000000000000351. PMID: 26811316.

7. Gustad L.T. Laugsand L.E., Janszky I. et al. Symptoms of anxiety and depression and risk of acute myocardial infarction: the HUNT 2 study. Eur Heart J 2014;35(21):1394–403. DOI: 10.1093/eurheartj/eht387.

8. Albert C.M., Chae C.U., Rexrode K.M. et al. Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women. Circulation 2005;111(4):480–7. DOI: 10.1161/01.CIR.0000153813.64165.5D. PMID: 15687137.

9. Lichtman J.H., Froelicher E.S., Blumenthal J.A. et al. Depression as a Risk Factor for Poor Prognosis Among Patients with Acute Coronary Syndrome: Systematic Review and Recommendations. A Scientific Statement From the American Heart Association. Circulation 2014;129(12):1350–69. DOI: 10.1161/CIR.0000000000000019.

10. Parker G.B., Hilton T.M., Walsh W.F. et al. Timing is everything the onset of depression and acute coronary syndrome outcome. Biol Psychiatry 2008;64(8): 660–6. DOI: 10.1016/j.biopsych.2008.05.021.

11. Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Mental Health Findings. 2012. http://www.samhsa.gov/data/sites/default/files/2011MHFDT/2k11MHFR/ Web/NSDUHmhfr2011.htm.

12. Whang W., Kubzansky L.D., Kawachi I. et al. Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses’ Health Study. J Am Coll Cardiol 2009;53(11): 950–8. DOI: 10.1016/j.jacc.2008.10.060.

13. Shah A.J., Veledar E., Hong Y. et al. Depression and history of attempted suicide as risk factors for heart disease mortality in young individuals. Arch Gen Psychiatry 2011;68(11):1135–42. DOI: 10.1001/archgenpsychiatry.2011.125.

14. Rutledge T., Linke S.E., Kranttz D.S. et al. Comorbid depression and anxiety symptoms as predictors of cardiovascular events: results from the NHLBI-sponsored Women’s Ishemia Syndrome Evaluation (WISE) study. Psychosom Med 2009;71(9):958–64. DOI: 10.1097/PSY.0b013e3181bd6062.

15. Yusuf S., Hawken S., Ounpuu S. et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364(9438):937–52. DOI: 10.1016/S0140-6736(04)17018-9. PMID: 15364185.

16. Васюк Ю.А., Лебедев А.В., Довженко Т .В. и др. Аффективные расстройства и инфаркт миокарда: клинико-функциональные взаимосвязи и возможности антидепрессивной терапии тианептином. Кардиология 2009;49(1):25–9. [Vasyuk Yu.A., Lebedev A.V., Dovzhenko T.V. et al. Affective disorder and myocardial infarction: clinical and functional relationships and possible antidepressant therapy tianeptine. Kardiologiya = Cardiology 2009;49(1):25–9. (In Russ.)].

17. Frasure-Smith N., Lesperance F., Juneau M. et al. Gender, depression, and one-year prognosis after myocardial infarction. Psychosom Med 1999;61(1):26–37. PMID: 10024065.

18. van Melle J.P., de Jonge P., Ormel I. et al. Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND-IT. Eur Heart J 2005;26(24):2650–6. DOI: 10.1093/ eurheartj/ehi480. PMID: 16143708.

19. Ziegelstein R.C., Thombs B.D. The brain and the heart: the twain meet. Eur Heart J 2005;26(24):2607–8. DOI: 10.1093/ eurheartj/ehi576. PMID: 16227312.

20. Thygesen K., Alpert J.S., Jaffe A.S. et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33(20):2551– 67. DOI: 10.1093/eurheartj/ehs184. PMID: 22922414.

21. Васюк Ю.А., Лебедев А.В., Довжен- ко Т .В., Семиглазова М.В. Аффективные расстройства при остром инфаркте миокарда и возможности их коррекции тианептином. Терапевтический архив 2010;82(10):28–33. [Vasyuk Yu.A., Lebedev A.V., Dovzhenko T.V., Semiglazova M.V. Affective disorders in acute myocardial infarction and possibilities of their correction tianeptine. Terapevticheskiy arkhiv = Therapeutic Archive 2010;82(10):28–33. (In Russ.)].

22. Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr Scan 1983;67(6):361–70. PMID: 6880820.

23. Beck A.T., Ward C.H., Mendelson M. et al. An inventory for measuring depression. Arc Gen Psychiatry 1961;4:561–71. PMID: 13688369.

24. Методика определения уровня субъективного контроля личности (УСК). Методические рекомендации. М., 1984. [The method of determining the level of subjective control (CTC). Methodical recommendations. Moscow, 1984. (In Russ.)].

25. Piepoli M.F., Hoes A.W., Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37(29):2315–81. DOI: 10.1177/2047487316653709.

26. Бурячковская Л.И., Полякова Е.О., Сумароков А.Б. Влияние депрессивных расстройств на развитие и исход сердечно-сосудистых заболеваний. Терапевтический архив 2006;78(11): 87–92. [Buryachkovskaya L.I., Polyako- va E.O., Sumarokov A.B. The effect of depressive disorders on the development and outcome of cardiovascular diseases. Terapevticheskiy arkhiv = Therapeutic Archive 2006;78(11):87–92. (In Russ.)].

27. Дьячкова-Рехтина Н.И., Рехтина Л.В., Бондарева З.Г., Короленко Ц.П. Алекситимия у женщин, перенесших инфаркт миокарда: роль нейрофизиологического метода коррекции в комплексной санаторной реабилитации. Клиническая медицина 2007;85(4):52–5. [D’yachkovaRekhtina N.I., Rekhtina L.V., Bondare- va Z.G., Korolenko Ts.P. Alexithymia in women after myocardial infarction: the role of neurophysiological correction method in complex sanatorium rehabilitation. Klinicheskaya meditsina = Clinical Medicine 2007;85(4):52–5. (In Russ.)].

28. Мухтаренко С.Ю., Мураталиев Т .М. Взаимосвязь алекситимии с качеством жизни и уровнем субъективного контроля личности у больных с коронарной болезнью сердца. Вестник Кыргызско-Российского Славянского университета 2007;2(7):133–7. [Mukhtarenko S.Yu., Murataliev T.M. The relationship of alexithymia with quality of life and level of subjective control of the person at patients with coronary heart disease. Vestnik KyrgyzskoRossiyskogo Slavyanskogo universiteta = Bulletin of The Kyrgyz-Russian Slavic University 2007;2(7):133–7. (In Russ.)].

29. Современные достижения в реабилитации больных инфарктом миокарда. Под ред. И.К. Шхвацабая, Г. Андерса. М.: Медицина, 1983. [Modern advances in the rehabilitation of patients with myocardial infarction. Eds. by: I.K. Shkhvatsabay, G. Anders. Moskow: Meditsina, 1983. (In Russ.)].

30. Sorensen C., Fris-Hasche E., Hadhfelt T., Bech P. Postmyocardial infarction mortality in relation to depression: a systematic critical review. Psychother Psychosom 2005;74(2):69–80. DOI: 10.1159/000083165. PMID: 15741756.

31. Дмитриев К.Д., Цейтина Г .П., Эткинд А.М. Уровень субъективного контроля у соматических больных и задачи реабилитации. Социально-психологические проблемы реабилитации нервно-психических больных. Сборник научных трудов. Л., 1984. С. 100–105. [Dmitriev K.D., Tseytina G.P., Etkind A.M. The level of subjective control in patients with somatic and objectives of rehabilitation. Socio-psychological problems of rehabilitation of neuropsychiatric patients. Collection of scientific works. Leningrad, 1984. Pp. 100–105. (In Russ.)].