Feigal Jacob P, Boyle Stephen H, Samad Zainab, Velazquez Eric J, Wilson Jennifer L, Becker Richard C, Williams Redford B, Kuhn Cynthia M, Ortel Thomas L, Rogers Joseph G, O'Connor Christopher M, Jiang Wei
Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States.
Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.
J Psychosom Res. 2017 Feb;93:14-18. doi: 10.1016/j.jpsychores.2016.11.012. Epub 2016 Nov 29.
Depressive symptoms have been associated with myocardial ischemia induced by mental (MSIMI) and exercise (ESIMI) stress in clinically stable ischemic heart disease (IHD) patients, but the association between positive emotions and inducible ischemia is less well characterized. The objective of this study was to examine the associations between ratings of well-being and stress-induced ischemia.
Subjects were adult patients with documented IHD underwent mental and exercise stress testing for the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) trial. The General Well-Being Schedule (GWBS), with higher scores reflecting greater subjective well-being, and the Center for Epidemiologic Studies Depression Scale (CES-D) were obtained from the REMIT participants. Echocardiography was used to measure ischemic responses to mental stress and Bruce protocol treadmill exercise testing. Data were analyzed using logistic regression adjusting for age, sex, resting left-ventricular ejection fraction (LVEF), and resting wall motion score index, as well as health-related behaviors.
GWBS scores were obtained for 210 individuals, with MSIMI present in 92 (43.8%) and ESIMI present in 64 (30.5%). There was a significant inverse correlation between GWBS-PE (Positive Emotion subscale) scores and probability of ESIMI (OR=0.55 (95%CI 0.36-0.83), p=0.005). This association persisted after additional control for CESD subscales measuring negative and positive emotions and for variables reflecting health-related behaviors. A similar inverse correlation between GWBS-PE and MSIMI was observed, but did not reach statistical significance (OR=0.81 (95%CI 0.54-1.20), p=0.28).
This is, to our knowledge, the first study demonstrating that greater levels of self-reported positive emotions are associated with a lower likelihood of ESIMI among patients with known IHD. Our results highlight the important interface functions of the central nervous and cardiovascular systems and underscore areas for future investigation.
在临床病情稳定的缺血性心脏病（IHD）患者中，抑郁症状与精神应激诱导的心肌缺血（MSIMI）和运动应激诱导的心肌缺血（ESIMI）有关，但积极情绪与诱发性缺血之间的关联尚未得到充分研究。本研究的目的是探讨幸福感评分与应激诱导的缺血之间的关联。
研究对象为成年IHD患者，他们参加了心肌缺血对艾司西酞普兰治疗反应（REMIT）试验的精神和运动应激测试。从REMIT参与者那里获取了总体幸福感量表（GWBS，得分越高反映主观幸福感越强）和流行病学研究中心抑郁量表（CES-D）。采用超声心动图测量精神应激和布鲁斯方案平板运动试验的缺血反应。使用逻辑回归分析数据，并对年龄、性别、静息左心室射血分数（LVEF）、静息壁运动评分指数以及健康相关行为进行校正。
210名个体获得了GWBS评分，其中92人（43.8%）存在MSIMI，64人（30.5%）存在ESIMI。GWBS-PE（积极情绪分量表）评分与ESIMI发生概率之间存在显著负相关（OR=0.55（95%CI 0.36-0.83），p=0.005）。在进一步控制测量消极和积极情绪的CESD分量表以及反映健康相关行为的变量后，这种关联仍然存在。观察到GWBS-PE与MSIMI之间存在类似的负相关，但未达到统计学显著性（OR=0.81（95%CI 0.54-1.20），p=0.28）。
据我们所知，这是第一项表明在已知IHD患者中，自我报告的积极情绪水平越高与ESIMI发生可能性越低相关的研究。我们的结果突出了中枢神经和心血管系统的重要交互作用，并强调了未来研究的方向。
