Bhattacharyya, M.R.; (2008) Psychological and biological factors in acute coronary heart disease. Doctoral thesis , University of London.

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Abstract

Psychosocial factors are thought to contribute to the long term development of coronary artery disease (CAD), to the triggering of cardiac events in people with advanced disease, and to adaptation following acute coronary syndromes (ACS). My thesis presents three studies addressing different aspects of the relationship between emotional factors and CAD, using different methodologies. They focus on the role of negative emotions in vulnerability to myocardial ischaemia in daily life, the influence of acute emotional triggers of ACS on long term quality of life, and the effect of depression following ACS on a particularly important aspect of adaptation, namely return to work. The first study, called the Silent Ischaemia Study (SIS) investigated 88 out-patients with suspected CAD who underwent 24 hour ambulatory electrocardiogram (ECG) monitoring, together with saliva sampling and characterisation of daily life by a new method called the Day Reconstruction Method (DRM). The results indicated that in patients with definite CAD, depressed mood was associated with reduced high frequency and increased low frequency heart rate variability (HRV), suggestive of parasympathetic withdrawal. The Cortisol slope over the day was flatter in more depressed patients with CAD. Episodes of transient ischaemia and/or arrhythmia were also associated with increased negative affect, but their incidence was low, primarily because most patients were medicated with beta blockers. The second and third studies derive from the ACCENT (Acute Coronary Syndrome, Emotion and Triggers) study, exploring long term adaptation following ACS. Analyses showed that the likelihood of returning to work was negatively associated with depression immediately following ACS, independently of clinical and demographic factors, and that emotional triggers predicted elevated anxiety and poor mental health status at 12 and 36 months independently of covariates. In combination, these studies suggest that negative emotional status contribute both to the onset of acute cardiac events, and to adaptation following ACS.

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