Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, German Center for Cardiovascular Research, Partner Site Berlin, Germany.
Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
J Psychosom Res. 2021 Dec;151:110659. doi: 10.1016/j.jpsychores.2021.110659. Epub 2021 Oct 28.
A hyper-coagulant state is a biological mechanism that triggers cardiac events in patients with coronary artery disease (CAD). Depressive symptoms and anxiety predict an unfavourable course of CAD. The SPIRR-CAD-RCT examined the effects of a psychological intervention and provided the opportunity to explore cross-sectional associations between indices of psychological strain and coagulation parameters, as well as prospective changes in depression scores and coagulation parameters.
In this secondary analysis, we investigated 253 CAD patients (194 male; age m 58.9, SD 8.3 yrs.) with mild to moderate depression (≥8 on the HADS-D) at baseline and at follow-up 18 months later: TF, fibrinogen, D-dimer, VWF, FVII and PAI-1 and the course of depression (HAM-D), vital exhaustion (VE) and anxiety scores (HADS-A) were examined by ANOVA in the total and younger age groups (≤ 60).
HAM-D at baseline was correlated with TF (corr. R = 0.27; F = 9.31, p = 0.001). HADS anxiety was associated with fibrinogen (corr. R.20; F = 7.27, p = 0.001). There was no detectable therapeutic effect on coagulation. Fibrinogen and VWF decreased within 18 months (time effect; p = 0.02; p = 0.04), as did HADS-D in both treatment groups (p < 0.001). Fibrinogen decreased more in patients ≤60 years with high VE compared to low VE (interaction time x group, p = 0.01).
This is the first study to show an association between TF and depression. Coagulation parameters as potential mediators of CAD progression correlated cross-sectionally with depression and anxiety and prospectively with VE. Further studies should replicate these correlations in depressed and non-depressed CAD patients.
76240576; clinicaltrials.gov.
高凝状态是触发冠心病（CAD）患者心脏事件的生物学机制。抑郁症状和焦虑预示着 CAD 病程不佳。SPIRR-CAD-RCT 研究了心理干预的效果，并提供了机会来探讨心理压力指数与凝血参数之间的横断面关联，以及抑郁评分和凝血参数的前瞻性变化。
在这项二次分析中，我们调查了 253 名基线时有轻度至中度抑郁（HADS-D 评分≥8）的 CAD 患者（194 名男性；年龄均为 58.9 岁，标准差为 8.3 岁），并在 18 个月后进行随访：TF、纤维蛋白原、D-二聚体、vWF、FVII 和 PAI-1 以及抑郁（HAMD）的病程、活力衰竭（VE）和焦虑评分（HADS-A）通过方差分析在总人群和年龄较小的人群（≤60 岁）中进行了检查。
基线时的 HAMD 与 TF 相关（相关 R=0.27；F=9.31，p=0.001）。HADS 焦虑与纤维蛋白原相关（相关 R.20；F=7.27，p=0.001）。在凝血方面没有发现可检测到的治疗效果。纤维蛋白原和 vWF 在 18 个月内下降（时间效应；p=0.02；p=0.04），两个治疗组的 HADS-D 也下降（p<0.001）。VE 较高的患者≤60 岁的纤维蛋白原下降幅度大于 VE 较低的患者（时间与组的交互作用，p=0.01）。
这是第一项表明 TF 与抑郁相关的研究。凝血参数作为 CAD 进展的潜在介质，与抑郁和焦虑呈横断面相关，与 VE 呈前瞻性相关。进一步的研究应该在抑郁和非抑郁的 CAD 患者中复制这些相关性。
76240576；clinicaltrials.gov。
