Key result
In patients with coronary heart disease, every 5-point increase in perceived stress score was associated with a 25% increased risk of major adverse cardiovascular events (HR 1.25).
Why the study?
The study was conducted to determine the association of perceived stress with coagulation function and assess their predictive values for clinical outcomes.
Does high perceived stress increase the risk of major adverse cardiovascular events and shorten APTT in patients with coronary heart disease?
Cohort (n=241)
No
Does high perceived stress increase the risk of major adverse cardiovascular events and shorten APTT in patients with coronary heart disease?
Effect estimate: HR 1.25 (95% CI 1.04-1.51)
p-value: p=0.020
High perceived stress in patients with coronary heart disease is associated with shortened APTT and independently predicts worse cardiovascular outcomes.
High perceived stress was associated with increased MACE risk in coronary disease; leaves open whether stress-reduction interventions improve outcomes.
Objective: To determine the association of perceived stress with coagulation function and their predictive values for clinical outcomes. Methods: This prospective cohort study derived from a cross-sectional study for investigating the psychological status of inpatients with suspicious coronary heart disease (CHD). In this study, the 10-item Perceived Stress Scale (PSS-10) as an optional questionnaire was used to assess the severity of perceived stress. Coagulation function tests, such as activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen were measured within 1 h after admission. Furthermore, 241 patients with CHD out of 705 consecutive inpatients were included in the analyses and followed with a median of 26 months for the clinical outcomes. Results: The patients in high perceived stress status (PSS-10 score > 16) were with shorter APTT (36.71 vs. 38.45 s, p = 0.009). Shortened APTT ( ≤ 35.0 s) correlated with higher PSS-10 score (14.67 vs. 11.22, p = 0.003). The association of APTT with depression or anxiety was not found. Multiple linear models adjusting for PT estimated that every single point increase in PSS-10 was relevant to approximately 0.13 s decrease in APTT ( p = 0.001) regardless of the type of CHD. APTT (every 5 s increase: hazard ratio ( HR ) 0.68 [0.47–0.99], p = 0.041) and perceived stress (every 5 points increase: HR 1.31 [1.09–1.58], p = 0.005) could predict the cardiovascular outcomes. However, both predictive values would decrease when they were simultaneously adjusted. After adjusting for the physical clinical features, the associated of perceived stress on cardiac ( HR 1.25 [1.04–1.51], p = 0.020) and composite clinical outcomes ( HR 1.24 [1.05–1.47], p = 0.011) persisted. Conclusions: For the patients with CHD, perceived stress strongly correlates with APTT. The activation of the intrinsic coagulation pathway is one of the mechanisms that high perceived stress causes cardiovascular events. This hints at an important role of the interaction of mental stress and coagulation function on cardiovascular prognosis. More attention needs to be paid to the patients with CHD with high perceived stress.
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Yin et al. (2021) conducted a cohort in Coronary heart disease (n=241). Perceived stress (per 5-point increase in PSS-10 score) was evaluated on Major adverse cardiovascular events (MACE) (HR 1.25, 95% CI 1.04-1.51, p=0.020). In patients with coronary heart disease, every 5-point increase in perceived stress score was associated with a 25% increased risk of major adverse cardiovascular events (HR 1.25).
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