Sengül Cihan, Ozveren Olcay, Cevik Cihan, Izgi Cemil, Karavelioğlu Yusuf, Oduncu Vecih, Akgün Taylan, Can Mehmet Mustafa, Ozdemir Nihal, Ozkan Mehmet
Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2011 Jul;39(5):396-402. doi: 10.5543/tkda.2011.01412.
Several studies have shown that psychosocial risk factors such as stress and depression make substantial contribution to the pathogenesis of coronary artery disease. This study aimed to investigate acute stress factors prior to acute myocardial infarction (AMI), and stress, depression, and anxiety levels during the subacute period in AMI patients aged ≤ 40 years, in comparison with AMI patients aged >40 years.
The study included 200 first-time AMI patients aged ≤ 40 years (n=100; mean age 35 ± 4 years) and >40 years (n=100; mean age 54 ± 9 years). The DASS 21 scale (Depression Anxiety Stress Scales) was administered via face-to-face interviews in the early recovery period of AMI. The patients were also questioned whether they had experienced acute stress factors such as severe emotional or physical stressful events within two hours before the onset of chest pain. In addition, coronary angiography results were assessed based on the two age groups.
Comparison of the two age groups showed significantly higher frequencies of family history of CAD and smoking in the younger group, and significantly higher frequencies of hypertension, diabetes mellitus, and dyslipidemia in the older group (p<0.05). History of acute stress factors was significantly more common (52% vs. 20%, p<0.01) and stress, depression, and anxiety scores of the DASS 21 scale were all significantly higher in the younger group (p<0.01). On coronary angiography, younger patients predominantly had normal coronary arteries and single-vessel disease, whereas multi-vessel disease was more prevalent in the older age group (p<0.01).
Triggers of acute stress and psychosocial risk factors may contribute to the occurrence of AMI in individuals younger than 40 years.
多项研究表明，压力和抑郁等社会心理风险因素对冠状动脉疾病的发病机制有重大影响。本研究旨在调查急性心肌梗死（AMI）发作前的急性应激因素，以及年龄≤40岁的AMI患者亚急性期的压力、抑郁和焦虑水平，并与年龄>40岁的AMI患者进行比较。
该研究纳入了200例首次发生AMI的患者，其中年龄≤40岁的患者100例（平均年龄35±4岁），年龄>40岁的患者100例（平均年龄54±9岁）。在AMI早期恢复期通过面对面访谈的方式使用DASS 21量表（抑郁焦虑压力量表）。还询问患者在胸痛发作前两小时内是否经历过严重情绪或身体应激事件等急性应激因素。此外，根据两个年龄组评估冠状动脉造影结果。
两个年龄组的比较显示，较年轻组中CAD家族史和吸烟的频率显著更高，而较年长组中高血压、糖尿病和血脂异常的频率显著更高（p<0.05）。急性应激因素史在较年轻组中明显更常见（52%对20%，p<0.01），并且DASS 21量表的压力、抑郁和焦虑评分在较年轻组中均显著更高（p<0.01）。在冠状动脉造影中，较年轻患者主要有正常冠状动脉和单支血管病变，而多支血管病变在较年长组中更普遍（p<0.01）。
急性应激触发因素和社会心理风险因素可能促成40岁以下个体发生AMI。
