Association of Systemic Inflammation with Mental Health Symptoms in Post-Myocardial Infarction Populations Open Access

Buto, Peter (Spring 2021)

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Background: Adverse mental health conditions including depression, PTSD, and anxiety are prevalent among patients who survive myocardial infarctions (MI) and are associated with worsened outcomes. The mechanisms underlying these associations, however, are still not well understood. Inflammatory pathways are one proposed pathway by which mental health my affect cardiovascular outcomes. In an exploratory analysis, we examined the bidirectional association between mental health symptoms and inflammatory biomarkers in a younger post MI population. We further examined how this association may differ between females and males as well as between Black and non-Black individuals. Methods: Participants included individuals with early onset MI between the ages 18 and 60. Mental health scores for depression, PTSD, perceived stress, and anxiety as well as inflammatory biomarkers, interleukin-6 (IL-6) and C-reactive protein (CRP), were collected at baseline and sixmonth follow up. Exploratory analysis examined changes in mental health symptoms as a function of inflammatory markers at baseline and changes in inflammatory markers as a function of mental health symptoms at baseline. We then focused on one direction: PTSD subscales as the outcome of inflammatory markers at baseline. Results: Among 244 patients in the study (mean age: 50.8, 48.4% female, 64.3% Black), the average IL-6 level at rest was 1.7 pg/mL and average CRP was 2646.6 ng/mL. Mental health scores at baseline did not predict changes in inflammatory biomarkers. Inflammatory biomarkers at baseline did not show a significant association with most of the mental health scales, however, both IL-6 and CRP were significantly associated with changes in re-experiencing PTSD symptoms. This association was more pronounced in Black individuals and females, however, the magnitudes only significantly differed by race (but not sex). Conclusion: MI patients with higher levels of inflammation at baseline exhibited greater changes in re-experiencing PTSD symptoms over a six month follow-up period, suggesting a mechanistic link between PTSD and cardiovascular health through inflammation. 

Table of Contents


Background. 1

Mechanisms Linking Coronary Heart Disease and Mental Health. 1

Coronary Heart Disease and Inflammation. 2

Inflammation and Mental Health. 2

Inflammation and Mental Health: Longitudinal Pathways. 4

Possible Effect Modification in Subgroups. 5

Methods: 7

Study Design and Sample. 7

Measurements. 8

Statistical Analysis. 9

Results: 11

Descriptive Characteristics. 11

Bidirectional Exploratory Analysis Between Mental Health Scores and Inflammatory Biomarkers. 12

Associations Between Baseline Inflammatory Markers & PTSD Symptoms – Multivariate Mixed Models Analysis. 13

Stratified Analysis. 13

Discussion: 15

Strengths and Limitations: 17

Conclusion. 18

Tables. 19

Figures. 25

Work Cited. 26

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