The Effect Of Anxiety And Depression On Inflammatory Factors And Endothelial Function In Patients With Coronary Heart Disease

PurposeTo investigate the effects and mechanisms of anxiety and depression on the serum levels of inflammatory factors and endothelial function in the patients with coronary heart disease (CHD).MethodsWe selected sixty patients with established CHD(CHD group), who were divided into two groups with or without anxiety and depression by designated scales. Twenty-one people free of CHD, anxiety and depression became the control group. The serum levels of inflammatory factors including high-sensitive C-reactive protein(Hs-CRP), intracellular adhesive molecule-1(IC AM-1) and tumor necrosis factor-α(TNF-α) were assessed, and the flow-mediated dilatation of the brachial artery(FMD) was evaluated by Doppler ultrasound method. The differences of these variables in these three groups were compared and their relationship was analyzed.Results(1) The heart rate of the CHD patients with anxiety and depression was faster than the patients without anxiety and depression (p<0.05).(2) The serum levels of Hs-CRP, ICAM-1 and TNF-αin the CHD patients with anxiety and depression group were 4.37±2.96mg/L, 10.11±4.33ng/ml,119.4±43.22pg/ml respectively, which were significantly higher than those in the control group (1.78±1.05mg/L, 4.09±2.57ng/ml,66.81±27.81pg/ml)(allp<0.01). The three inflammatory factors in the CHD patients without anxiety and depression group (3.17±1.85mg/L,6.57±4.95ng/ml,86.08±51.74pg/ml) were also higher than those in the control group, but only Hs-CRP level had statistical significance (p<0.01). The levels of Hs-CRP, ICAM-1 and TNF-a in the CHD patients with anxiety and depression group were higher than those in the group without anxiety and depression, and the differences of ICAM-1 and TNF-αlevels between the two groups had statistical significance(all p<0.05).(3) The CHD patients showed significantly attenuated FMD compared with the control group (p<0.01). Compared with the CHD patients without anxiety and depression, the patients with anxiety and depression also showed significantly attenuated FMD (p<0.05).(4) Pearson correlation analysis showed that FMD had a negative correlation with heart rate(HR), levels of total cholesterol(TC) and low density lipoprotein-cholesterol (LDL-C), anxiety/depression scale score, levels of Hs-CRP, ICAM-1 and TNF-α(r were-0.290,-0.214,-0.265,-0.450,-0.366,-0.247,-0.430,-0.465,-0.491,-0.562,respectively, all p<0.05). After control the HR,TC and LDL-C used partial correlation analysis, it still showed that FMD had a negative correlation with anxiety/depression scale score, Hs-CRP and ICAM-1 levels(the coefficient of partial correlation R were-0.387,-0.402,-0.436,-0.522,-0.431,-0.295, respectively, all p<0.01). We also analyzed the correlation between anxiety/depression scale score and other factors, and we found that scale score had a positive correlation with HR, serum Hs-CRP, ICAM-1 and TNF-αlevels(all<0.05).Conclusions(ⅰ) The levels of inflammatory factors in CHD patients are increasing and even higher in those with anxiety and depression. This indicates that anxiety and depression may prompt body inflammatory response in CHD patients.(ⅱ) The CHD patients have endothelial function disorder which is more obvious in patients with anxiety and depression.(ⅲ) The intensification of inflammatory reaction may be the mechanism of aggravation of the endothelial dysfunction in CHD patients with anxiety and depression.