Enhanced platelet/endothelial activation in depressed patients with acute coronary syndromes
- 1 September 2003
- journal article
- Published by Wolters Kluwer Health in Blood Coagulation & Fibrinolysis
- Vol. 14 (6) , 563-567
- https://doi.org/10.1097/00001721-200309000-00008
Abstract
Platelets play a key role in the progression of acute coronary syndromes (ACS). Clinical depression alone is also associated with enhanced platelet activation. The purpose of this study was to compare concentrations of established biomarkers of enhanced platelet/endothelial activation in clinically depressed versus non-depressed patients enrolled in recent clinical trials for ACS. Two hundred and eighty-one baseline plasma samples from patients with acute myocardial infarction (ASSENT-2; n = 41), with ACS (PRONTO; n = 126) and with clinical depression plus previous acute coronary syndrome within 6 months (SADHART; n = 64), and from normal healthy controls (n = 50) were analyzed. Blood was drawn before applying any therapeutic strategies including interventions, thrombolytics, infusions, and selective serotonin re-uptake inhibitors. Platelet factor 4, beta-thromboglobulin, platelet/endothelial cell adhesion molecule-1, P-selectin, thromboxane, prostacyclin, vascular cell adhesion molecule-1, and E-selectin were measured by enzyme-linked immunosorbent assay by a single core laboratory. Patients with ACS exhibited a higher degree of platelet activation than controls independently of the presence of depression. Plasma levels of P-selectin, thromboxane, prostacyclin, and vascular cell adhesion molecule-1 were the highest in the acute myocardial infarction group when compared with ACS despite the presence or absence of clinical depression. Surprisingly, patients with ACS and depression exhibited the highest levels of platelet factor 4, beta-thromboglobulin, and platelet/endothelial cell adhesion molecule-1 when compared with myocardial infarction or angina patients without clinical depression. E-selectin plasma level was constantly elevated compared with controls but did not differ among the groups dependent on the incidence of depression. The depressed plus ACS group had higher plasma levels of all biomarkers compared with the non-depressed patients. Retrospective analysis of the data from several clinical trials reveals that clinical depression is associated with enhanced activation of platelet/endothelial biomarkers even above the level expected in ACS. These findings may contribute to the unfavorable outcome associated with clinical depression in patients with ACS.Keywords
This publication has 27 references indexed in Scilit:
- Onset and extent of platelet inhibition by clopidogrel loading in patients undergoing elective coronary stenting: The Plavix Reduction Of New Thrombus Occurrence (PRONTO) trialAmerican Heart Journal, 2003
- Sertraline Treatment of Major Depression in Patients With Acute MI or Unstable AnginaJAMA, 2002
- Platelet Inhibition by Sertraline and N-Desmethylsertraline: A Possible Missing Link Between Depression, Coronary Events, and Mortality Benefits of Selective Serotonin Reuptake InhibitorsPharmacological Research, 2001
- The effect of citalopram treatment on platelet serotonin function in panic disordersInternational Clinical Psychopharmacology, 2000
- Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trialThe Lancet, 1999
- Platelet Activation and Inhibition in Unstable Coronary SyndromesThe American Journal of Cardiology, 1997
- Depression and 18-Month Prognosis After Myocardial InfarctionCirculation, 1995
- Platelets and coronary heart disease: potential psychophysiologic mechanisms.Psychosomatic Medicine, 1991
- Biochemical evidence of platelet activation in patients with persistent unstable anginaJournal of the American College of Cardiology, 1987
- Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death.Circulation, 1986