Almuwaqqat Zakaria, Wittbrodt Matthew, Young An, Lima Bruno B, Hammadah Muhammad, Garcia Mariana, Elon Lisa, Pearce Bradley, Hu Yingtian, Sullivan Samaah, Mehta Puja K, Driggers Emily, Kim Ye Ji, Lewis Tene T, Suglia Shakira F, Shah Amit J, Bremner J Douglas, Quyyumi Arshed A, Vaccarino Viola
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, Georgia.
JAMA Cardiol. 2021 Mar 1;6(3):336-340. doi: 10.1001/jamacardio.2020.5749.
Compared with older patients, young adults with a history of myocardial infarction (MI) tend to have a higher burden of psychosocial adversity. Exposure to early-life stressors may contribute to the risk of adverse outcomes in this patient population, potentially through inflammatory pathways.
To investigate the association of early-life trauma with adverse events and examine whether inflammation plays a role.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients aged 18 to 60 years with a verified history of MI in the past 8 months from a university-affiliated hospital network. Baseline data were collected from June 2011 to March 2016, and follow-up data were obtained through July 2019. Analysis began September 2019.
Early-life trauma was assessed using the Early Trauma Inventory-Self Report short form (ETI-SR-SF), both as a continuous and as a binary variable at the threshold of a score of 7 or higher. Inflammatory biomarkers, interleukin 6, and C-reactive protein were obtained at baseline.
A composite end point of recurrent MI, stroke, heart failure hospitalization, and cardiovascular death over a median 3-year follow-up.
Of 300 patients, the mean (SD) age was 51 (7) years, 198 (66%) were African American, and 150 (50%) were women. Compared with participants with MI with an ETI-SR-SF score less than 7, those with a score of 7 or higher had higher levels of interleukin 6 and C-reactive protein at baseline. Compared with participants with an ETI-SR-SF score less than 7, those with a score of 7 or higher were at a greater risk for adverse outcomes, with a hazards ratio of 2.3 (95% CI, 1.3-3.9). Results remained consistent in multivariable analysis. Further adjustment for C-reactive protein rendered the results no longer statistically significant. Early-life trauma displayed a dose-dependent response when analyzed as a continuous variable and by quartiles.
Early-life trauma is an independent risk factor for adverse outcomes in young and middle-aged individuals with a history of MI. Neurobiological mechanisms leading to lifetime activation of systemic inflammatory cascades may be implicated.
与老年患者相比，有心肌梗死（MI）病史的年轻人往往承受着更高的心理社会逆境负担。早年暴露于应激源可能会增加该患者群体出现不良结局的风险，这可能是通过炎症途径实现的。
研究早年创伤与不良事件之间的关联，并探讨炎症是否起作用。
设计、背景和参与者：这项队列研究纳入了来自大学附属医院网络的年龄在18至60岁之间、在过去8个月内有确诊MI病史的患者。基线数据于2011年6月至2016年3月收集，随访数据截至2019年7月。分析于2019年9月开始。
使用早期创伤量表-自我报告简表（ETI-SR-SF）评估早年创伤，既作为连续变量，也作为得分7分及以上的二分变量。在基线时获取炎症生物标志物、白细胞介素6和C反应蛋白。
在中位3年的随访期内，复发性MI、中风、心力衰竭住院和心血管死亡的复合终点。
300名患者的平均（标准差）年龄为51（7）岁，198名（66%）为非裔美国人，150名（50%）为女性。与ETI-SR-SF得分低于7分的MI参与者相比，得分7分及以上者在基线时白细胞介素6和C反应蛋白水平更高。与ETI-SR-SF得分低于7分的参与者相比，得分7分及以上者出现不良结局的风险更高，风险比为2.3（95%CI，1.3 - 3.9）。多变量分析结果保持一致。进一步对C反应蛋白进行校正后，结果不再具有统计学意义。将早年创伤作为连续变量并按四分位数分析时，显示出剂量依赖性反应。
早年创伤是有MI病史的中青年个体出现不良结局的独立危险因素。可能涉及导致全身炎症级联反应终生激活的神经生物学机制。
