Anxiety is a better predictor of platelet reactivity in coronary artery disease patients than depression.
Anxiety is a better predictor of platelet reactivity in coronary artery disease patients than depression.
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DOI：
10.1093/eurheartj/ehp602
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发表时间：
2010-07
影响因子：
39.3
通讯作者：
M. U. Zafar;M. Paz-Yepes;D. Shimbo;G. Vilahur;M. Burg;M. Burg;W. Chaplin;V. Fuster;K. Davidson;J. Badimón
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文献类型：
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作者：
M. U. Zafar;M. Paz-Yepes;D. Shimbo;G. Vilahur;M. Burg;M. Burg;W. Chaplin;V. Fuster;K. Davidson;J. Badimón
AIMS抑郁和焦虑与冠状动脉事件有关，但其机制(S)尚不清楚。在一项横断面研究中，我们调查了冠心病(CAD)患者抑郁和焦虑与5-羟色胺介导的血小板过度活动的关系。方法与结果在急性冠状动脉事件发生3个月后，83例服用阿司匹林和氯吡格雷的冠心病患者接受抑郁(Beck抑郁量表)和焦虑(医院焦虑和抑郁量表)的评估，并测定他们的血小板反应性(光学聚集法和流式细胞仪)，对二磷酸腺苷(ADP=5微米)和两种5-羟色胺+肾上腺素剂量[5HT：E(L)=4微米+4微米和5HT：E(H)=10微米+4微米]的血小板反应性进行测定。抑郁和焦虑患者的血小板反应性显著高于单纯抑郁或非抑郁和非焦虑患者。聚集性(平均+/-SE)：5HT：E(L)为41.9+/-2.6%比32.2+/-2.6%比30.4+/-3.7%；5HT：E(H)为46.9+/-2.7%比35.6+/-2.7%比31.7+/-3.8%(P<；0.05)。ADP聚集的差异并不显著，可能是因为氯吡格雷治疗的原因。流式细胞仪检测结果相似。在调整了年龄、体重指数和彼此之间的多元线性回归模型中，焦虑症状独立地预测了所有5-羟色胺：E-介导的血小板反应性指标，而抑郁则没有预测。结论在稳定期冠心病患者中，焦虑与5-羟色胺介导的血小板反应性升高有关，焦虑症状与血小板功能有很强的、独立的相关性。
AIMS Depression and anxiety are linked to coronary events but the mechanism(s) remains unclear. We investigated the associations of depression and anxiety with serotonin-mediated platelet hyperactivity in coronary artery disease (CAD) patients in a cross-sectional study. METHODS AND RESULTS Three months after an acute coronary event, stable CAD patients (n = 83) on aspirin and clopidogrel were evaluated for depression (beck depression inventory) and anxiety (hospital anxiety and depression scale), and their platelet reactivity was measured (optical aggregometry and flow cytometric fibrinogen binding in response to adenosine diphosphate (ADP = 5 microM) and two serotonin + epinephrine doses [5HT:E (L) = 4 microM + 4 microM and 5HT:E (H) = 10 microM + 4 microM]. Platelet reactivity was significantly higher in depressed and anxious than in depressed only or non-depressed-and-non-anxious patients. Aggregation (mean +/- SE) was 41.9 +/- 2.6% vs. 32.2 +/- 2.6% vs. 30.4 +/- 3.7% with 5HT:E (L) and 46.9 +/- 2.7% vs. 35.6 +/- 2.7% vs. 31.7 +/- 3.8% with 5HT:E (H) (P < 0.05 for both). Differences in ADP aggregations were not significant, perhaps because of clopidogrel therapy. Flow cytometry findings were similar. In a multivariate linear regression model adjusted for age, body mass index, and each other, anxiety symptoms independently predicted all 5HT:E-mediated platelet reactivity measures, whereas depression predicted none. CONCLUSION Anxiety is associated with elevated serotonin-mediated platelet reactivity in stable CAD patients and symptoms of anxiety show strong, independent correlations with platelet function.