Patients with acute coronary syndromes (ACS) who are diagnosed with major depression are at greater risk for subsequent major adverse coronary events (MACE). Major depression is associated with increased inflammatory protein levels, but only in certain individuals. In a prospective cohort study of ACS patients, with a nested case-control component, we propose to test a biobehavioral model in which major depression interacts with inflammatory protein gene polymorphisms resulting in even greater increases in inflammatory protein levels than those caused by either depression or gene polymorphisms alone. We expect to identify a well-defined, high-risk subgroup of ACS patients in which the interaction of depression and the genetic polymorphisms identified increases risk of subsequent MACE (myocardial infarctions, revascularization procedures, strokes, and death) more than does either of these factors alone, in part because of their combined effect of increasing inflammatory proteins. Inflammatory proteins and genes measured include: Interleukin (IL) 6, C-reactive Protein (CRP), Tumor Necrosis Factor Alpha (TNF?), E-Selectin (SELE), and Monocyte Chemoattractant Protein-1 (MCP-1). Major depression, inflammatory protein levels and genotype from patients who are positive for subsequent major adverse coronary events (MACE) (cases) during the 12 month study will be compared with these factors from subjects who are negative for MACE (controls). To test these hypotheses, eligible patients from a single large tertiary care center will be identified, consented, and enrolled into the study during their hospitalization for ACS. Blood samples for genes will be collected once only;whereas inflammatory protein measurements, depression, and confounding factor data will be collected at 6-8 weeks and 7 months after hospital discharge. At 12 months, follow-up data for MACE will be collected by telephone interview. The Depression Interview and Structured Hamilton (DISH) will be used to diagnose major depression. Data will be analyzed using multiple logistic regression.

Public Health Relevance

The discovery of a relationship among depression, genetics, inflammatory protein levels, and subsequent MACE in an ACS subgroup would provide a rationale for studying environmental triggers of depression and the effects of depression interventions (different medications, psychotherapies, combinations of treatment, and self-management techniques such as exercise) on inflammatory protein levels for their effects on future MACE. The ability to decrease mortality and morbidity in ACS patients would benefit public health efforts, particularly efforts to improve the health of older persons, who are more prone to coronary events.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
3R01NR010235-03S2
Application #
7778082
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Huss, Karen
Project Start
2009-07-20
Project End
2011-05-31
Budget Start
2009-07-20
Budget End
2011-05-31
Support Year
3
Fiscal Year
2009
Total Cost
$209,894
Indirect Cost
Name
University of Texas Health Science Center Houston
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
800771594
City
Houston
State
TX
Country
United States
Zip Code
77225
Sanner, Jennifer; Grove, Megan L; Yu, Erica et al. (2018) Effects of Gender-Specific Differences, Inflammatory Response, and Genetic Variation on the Associations Among Depressive Symptoms and the Risk of Major Adverse Coronary Events in Patients With Acute Coronary Syndrome. Biol Res Nurs 20:168-176
Yammine, Luba; Frazier, Lorraine; Padhye, Nikhil S et al. (2017) Two-year prognosis after acute coronary syndrome in younger patients: Association with feeling depressed in the prior year, and BDI-II score and Endothelin-1. J Psychosom Res 99:8-12
Yammine, Luba; Frazier, Lorraine; Padhye, Nikhil S et al. (2014) Severe depressive symptoms are associated with elevated endothelin-1 in younger patients with acute coronary syndrome. J Psychosom Res 77:430-4
Frazier, Lorraine; Sanner, Jennifer; Yu, Erica et al. (2014) Using a single screening question for depressive symptoms in patients with acute coronary syndrome. J Cardiovasc Nurs 29:347-53
Sanner, Jennifer E; Frazier, Lorraine; Udtha, Malini (2013) Effects of delayed laboratory processing on platelet serotonin levels. Biol Res Nurs 15:13-6
Yammine, Luba; Frazier, Lorraine (2013) Comparison of demographic, psychosocial, and clinical characteristics among younger and older persons with acute coronary syndrome. J Am Assoc Nurse Pract 25:103-8
Sanner, J E; Frazier, L; Udtha, M (2013) Self-reported depressive symptoms in women hospitalized for acute coronary syndrome. J Psychiatr Ment Health Nurs 20:913-20
Sanner, Jennifer E; Frazier, Lorraine; Udtha, Malini (2013) The role of platelet serotonin and depression in the acute coronary syndrome population. Yale J Biol Med 86:5-13
Virani, Salim S; Brautbar, Ariel; Lee, Vei-Vei et al. (2012) Chromosome 9p21 single nucleotide polymorphisms are not associated with recurrent myocardial infarction in patients with established coronary artery disease. Circ J 76:950-6
Virani, Salim S; Brautbar, Ariel; Lee, Vei-Vei et al. (2011) Usefulness of single nucleotide polymorphism in chromosome 4q25 to predict in-hospital and long-term development of atrial fibrillation and survival in patients undergoing coronary artery bypass grafting. Am J Cardiol 107:1504-9

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