Jamal A Hanash1; Baiba H Hansen1; Morten Birket-Smith1; Olav W Nielsen2; Alice Rasmussen3; Ahmad Sajadieh4; Jørgen F Hansen4
1 Psychiatric Cntr Bispebjerg， Copenhagen， Denmark
2 Bispebjerg Univ Hosp， Copenhagen， Denmark
3 Psychiatric Cntr Bispebjerg， Copenhagen， Denmark
4 Bispebjerg Univ Hosp， Copenhagen， Denmark
Background: Depression is associated with an adverse prognosis after acute coronary syndrome (ACS). Autonomic dysfunction and inflammation have been proposed as linking mechanisms. Much less is known about minor depressive symptoms. We aimed to examine the associations between minor depressive symptoms and markers of the autonomic nervous system and inflammation in non-depressed post-ACS patients.
Methods: Two hundred forty post-ACS patients without depression were enrolled in the DEpression in patients with Coronary ARtery Disease (DECARD) trial. Patients not meeting the ICD-10 diagnostic criteria for depressive episode， as well as having a score of <13 on Hamilton Rating Scale for Depression (Ham-D) were eligible. Scores of >7 on the Ham-D were defined as significant depressive symptoms. At the same time 24-h time-domain parameters of heart rate variability (HRV) and high sensitivity C-reactive protein (CRP) were measured.
Results: Forty-one patients (17.1%) had significant depressive symptoms. On univariate analysis， significant depressive symptoms were associated with lower meanNN (mean value of Normal-to-Normal [NN] intervals)， lower SDANN (standard deviation of the averages of NN intervals in all 5-min segments) and higher CRP. On multivariate analyses adjusting for sociodemography， life style， cardiovascular profile， medication， and comorbidity， significant depressive symptoms were significantly associated with lower age (0.01)， reduced physical activity (0.001)， lower meanNN (0.03) and only trend toward association with higher CRP (0.09). SDANN and meanNN were inversely correlated with CRP.
Conclusion: We found that minor depressive symptoms were significantly associated with reduced HRV and reduced physical activity， but only trend for association with CRP after ACS. Further， our results support the hypothesis of interplay between autonomic dysfunction and inflammation.