Prospective association between pro-inflammatory state on admission and posttraumatic stress following acute coronary syndrome

Roland von Känel; Rebecca E Meister-Langraf; Michaela Fux; Laurin Imholz; Aju P Pazhenkottil; Hansjörg Znoj; Jean-Paul Schmid; Claudia Zuccarella-Hackl; Jürgen Barth; Ulrich Schnyder; Mary Princip

doi:10.1016/j.genhosppsych.2021.12.003

Prospective association between pro-inflammatory state on admission and posttraumatic stress following acute coronary syndrome

Gen Hosp Psychiatry. 2022 Jan-Feb:74:58-64. doi: 10.1016/j.genhosppsych.2021.12.003. Epub 2021 Dec 10.

Authors

Affiliations

¹ Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: roland.vonkaenel@usz.ch.
² Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Clienia Schlössli AG, Oetwil am See, Zurich, Switzerland.
³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁴ University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
⁵ Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁶ Department of Health Psychology and Behavioral Medicine, University of Bern, Switzerland.
⁷ Department of Internal Medicine and Cardiology, Clinic Gais AG, Gais, Switzerland.
⁸ Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁹ Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹⁰ University of Zurich, Zurich, Switzerland.

PMID: 34915233
DOI: 10.1016/j.genhosppsych.2021.12.003

Abstract

Objective: The traumatic experience of acute coronary syndrome (ACS) may induce symptoms of posttraumatic stress disorder (PTSD). We examined whether the ACS-triggered acute inflammatory response predicts the development of PTSD symptoms.

Method: Study participants were 70 patients (all Caucasian, 80% male, mean age 59 years) with myocardial infarction (MI) during the acute treatment phase. Interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, IL-4, IL-10, and transforming growth factor (TGF)-1β were determined in plasma collected within 48 h of hospital admission. Participants self-assessed the severity of ACS-induced PTSD symptoms with the 17-item Posttraumatic Diagnostic Scale at 12 months.

Results: There was a significant positive association of the pro-inflammatory index (added standardized z-scores of pro-inflammatory cytokines IL-1β, IL-6, and TNF-α) with total PTSD symptom severity (ΔR² = 0.050, p = .029) and re-experiencing symptoms (ΔR² = 0.088, p = .008), but not avoidance/numbing and hyperarousal symptoms. Analyses were adjusted for the anti-inflammatory index (added standardized z-scores of IL-4, IL-10, and TGF-β1), trauma-focused counseling, sex, age, time since pain onset, troponin, body mass index, and distress during MI. Results were robust when the anti-inflammatory index was removed from the model. Additional analyses showed significant associations of both the net-inflammatory index (i.e., pro-inflammatory index minus anti-inflammatory index) and IL-1β with total PTSD symptom severity, re-experiencing, and hyperarousal symptoms (ΔR² between 0.042 and 0.090) and of IL-1β with avoidance/numbing symptoms (ΔR² = 0.050).

Conclusions: The findings suggest an association between the pro-inflammatory state launched during ACS and the development of PTSD symptoms. Increased IL-1β may play a particular role in the pathophysiology of ACS-induced PTSD symptoms.

Keywords: Cardiovascular disease; Cytokines; Inflammation; Longitudinal study; Psychological stress; Trauma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome* / epidemiology
Cytokines
Female
Humans
Male
Middle Aged
Myocardial Infarction*
Psychotherapy
Stress Disorders, Post-Traumatic* / diagnosis

Substances

Cytokines