Skip to main content

Advertisement

SpringerLink
Log in

Association Between Posttraumatic Stress Disorder Following Myocardial Infarction and Liver Enzyme Levels: A Prospective Study

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Research in rodents demonstrated that psychological stress increases circulating levels of alanine transaminase, aspartate transaminase, and alkaline phosphatase reflecting liver injury. Moreover, chronic posttraumatic stress disorder and transaminases predicted coronary heart disease.

Aims

To investigate the hypothesis that severity of posttraumatic stress disorder following myocardial infarction would prospectively relate to liver enzymes.

Methods

Study participants were 24 patients (mean 59 ± 7 years, 79% men) with an interviewer-rated diagnosis of posttraumatic stress disorder caused by an index myocardial infarction 3 ± 3 months before. After a mean follow-up of 26 ± 6 months, patients had a clinical interview to reassess posttraumatic stress disorder severity, a medical history, and blood collected to determine liver enzymes.

Results

Total posttraumatic stress disorder symptoms assessed at study entry prospectively predicted plasma levels of alanine transaminase (r = .47, p = .031) and alkaline phosphatase (r = .57, p = .004), but not of aspartate transaminase (p = .15), controlling for follow-up duration and antidepressant use. Total posttraumatic stress disorder symptoms assessed at follow-up were associated with alanine transaminase (r = .72, p = .004), aspartate transaminase (r = .60, p = .018), and alkaline phosphatase (r = .64, p = .001) in the 16 patients who had maintained diagnostic posttraumatic stress disorder, but not in all 24 patients.

Conclusions

The severity of posttraumatic stress disorder following myocardial infarction was associated with mild increase in liver enzyme levels, suggesting that chronic psychological stress relates to hepatic damage in humans. This might help to explain the previously observed increased cardiovascular risk in chronically traumatized individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med. 2000;342:1266–1271.

    Article  PubMed  CAS  Google Scholar 

  2. Schmidt FW, Schmidt E. Progress in the enzyme diagnosis of liver disease: reality or illusion? Clin Biochem. 1990;23:375–382.

    Article  PubMed  CAS  Google Scholar 

  3. Harris H. The human alkaline phosphatases: what we know and what we don’t know. Clin Chim Acta. 1990;186:133–150.

    Article  PubMed  CAS  Google Scholar 

  4. Sanchez O, Viladrich M, Ramírez I, Soley M. Liver injury after an aggressive encounter in male mice. Am J Physiol Regul Integr Comp Physiol. 2007;293:R1908–R1916.

    PubMed  CAS  Google Scholar 

  5. Salas M, Tuchweber B, Kourounakis P. Liver ultrastructure during acute stress. Pathol Res Pract. 1980;167:217–233.

    PubMed  CAS  Google Scholar 

  6. Matsuoka N, Arakawa H, Kodama H, Yamaguchi I. Characterization of stress-induced sudden death in cardiomyopathic hamsters. J Pharmacol Exp Ther. 1998;284:125–135.

    PubMed  CAS  Google Scholar 

  7. Adachi S, Kawamura K, Takemoto K. Oxidative damage of nuclear DNA in liver of rats exposed to psychological stress. Cancer Res. 1993;53:4153–4155.

    PubMed  CAS  Google Scholar 

  8. Chida Y, Sudo N, Kubo C. Does stress exacerbate liver diseases? J Gastroenterol Hepatol. 2006;21:202–208.

    Article  PubMed  CAS  Google Scholar 

  9. Fukudo S, Suzuki J, Tanaka Y, Iwahashi S, Nomura T. Impact of stress on alcoholic liver injury; a histopathological study. J Psychosom Res. 1989;33:515–521.

    Article  PubMed  CAS  Google Scholar 

  10. Irie M, Tsutsumi A, Shioji I, Kobayashi F. Effort–reward imbalance and physical health among Japanese workers in a recently downsized corporation. Int Arch Occup Environ Health. 2004;77:409–417.

    Article  PubMed  Google Scholar 

  11. Yehuda R. Post-traumatic stress disorder. N Engl J Med. 2002;346:108–114.

    Article  PubMed  CAS  Google Scholar 

  12. Tedstone JE, Tarrier N. Posttraumatic stress disorder following medical illness and treatment. Clin Psychol Rev. 2003;23:409–448.

    Article  PubMed  Google Scholar 

  13. Schelling G. Post-traumatic stress disorder in somatic disease: lessons from critically ill patients. Prog Brain Res. 2008;167:229–237.

    Article  PubMed  Google Scholar 

  14. Gurevich M, Devins GM, Rodin GM. Stress response syndromes and cancer: conceptual and assessment issues. Psychosomatics. 2002;43:259–281.

    Article  PubMed  Google Scholar 

  15. Spindler H, Pedersen SS. Posttraumatic stress disorder in the wake of heart disease: prevalence, risk factors, and future research directions. Psychosom Med. 2005;67:715–723.

    Article  PubMed  Google Scholar 

  16. Guler E, Schmid JP, Wiedemar L, Saner H, Schnyder U, von Känel R. Clinical diagnosis of posttraumatic stress disorder after myocardial infarction. Clin Cardiol. 2009;32:125–129.

    Article  PubMed  Google Scholar 

  17. Gander ML, von Känel R. Myocardial infarction and posttraumatic stress disorder: frequency, outcome, and atherosclerotic mechanisms. Eur J Cardiovasc Prev Rehabil. 2006;13:165–172.

    Article  PubMed  Google Scholar 

  18. Abbas CC, Schmid JP, Guler E, Wiedemar L, Begré S, Saner H, Schnyder U, von Känel R. Trajectory of posttraumatic stress disorder caused by myocardial infarction: a two-year follow-up study. Int J Psychiatry Med. 2009;39:359–376.

    Article  PubMed  Google Scholar 

  19. Boscarino JA. Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies. Ann N Y Acad Sci. 2004;1032:141–153.

    Article  PubMed  Google Scholar 

  20. Boscarino JA. A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Psychosom Med. 2008;70:668–676.

    Article  PubMed  Google Scholar 

  21. Shemesh E, Yehuda R, Milo O, et al. Posttraumatic stress, nonadherence, and adverse outcome in survivors of a myocardial infarction. Psychosom Med. 2004;66:521–526.

    Article  PubMed  Google Scholar 

  22. Kimerling R, Gima K, Smith MW, Street A, Frayne S. The Veterans Health Administration and military sexual trauma. Am J Public Health. 2007;97:2160–2166.

    Article  PubMed  Google Scholar 

  23. Brea A, Mosquera D, Martín E, et al. Nonalcoholic fatty liver disease is associated with carotid atherosclerosis: a case-control study. Arterioscler Thromb Vasc Biol. 2005;25:1045–1050.

    Article  PubMed  CAS  Google Scholar 

  24. Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis. 2001;21:17–26.

    Article  PubMed  CAS  Google Scholar 

  25. Wilson PW. Evidence of systemic inflammation and estimation of coronary artery disease risk: a population perspective. Am J Med. 2008;121(10 Suppl 1):S15–S20.

    Article  PubMed  Google Scholar 

  26. Oliveira AC, Oliveira AM, Almeida MS, et al. Alanine aminotransferase and high sensitivity C-reactive protein: correlates of cardiovascular risk factors in youth. J Pediatr. 2008;152:337–342.

    Article  PubMed  CAS  Google Scholar 

  27. Kerner A, Avizohar O, Sella R, et al. Association between elevated liver enzymes and C reactive protein: possible hepatic contribution to systemic inflammation in the metabolic syndrome. Arterioslcer Thromb Vasc Biol. 2005;25:193–197.

    CAS  Google Scholar 

  28. von Känel R, Hepp U, Kraemer B, et al. Evidence for low-grade systemic proinflammatory activity in patients with posttraumatic stress disorder. J Psychiatr Res. 2007;41:744–752.

    Article  Google Scholar 

  29. Schindhelm RK, Dekker JM, Nijpels G, et al. Alanine aminotransferase predicts coronary heart disease events: a 10-year follow-up of the Hoorn study. Atherosclerosis. 2007;191:391–396.

    Article  PubMed  CAS  Google Scholar 

  30. Adibi P, Sadeghi M, Mahsa M, Rozati G, Mohseni M. Prediction of coronary atherosclerotic disease with liver transaminase level. Liver Int. 2007;27:895–900.

    Article  PubMed  CAS  Google Scholar 

  31. Stieglitz RD, Frommberger U, Foa EB, Berger M. Evaluation of the German version of the PTSD Symptom Scale (PSS). Psychopathology. 2001;34:128–133.

    Article  PubMed  CAS  Google Scholar 

  32. Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale (PDS). Psychol Assess. 1997;9:445–451.

    Article  Google Scholar 

  33. Blake DD, Weathers FW, Nagy LM, et al. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995;8:75–90.

    Article  PubMed  CAS  Google Scholar 

  34. Schnyder U, Moergeli H. German version of clinician-administered PTSD scale. J Trauma Stress. 2002;15:487–492.

    Article  PubMed  Google Scholar 

  35. Schnyder U, Moergeli H, Trentz O, Klaghofer R, Buddeberg C. Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up. Am J Respir Crit Care Med. 2001;164:653–656.

    PubMed  CAS  Google Scholar 

  36. Babyak MA. What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med. 2004;66:411–421.

    Article  PubMed  Google Scholar 

  37. Perneger TV. What’s wrong with Bonferroni adjustments? BMJ. 1998;316:1236–1238.

    PubMed  CAS  Google Scholar 

  38. O’Donnell T, Hegadoren KM, Coupland NC. Noradrenergic mechanisms in the pathophysiology of post-traumatic stress disorder. Neuropsychobiology. 2004;50:273–283.

    Article  PubMed  CAS  Google Scholar 

  39. Yehuda R, Siever LJ, Teicher MH, et al. Plasma norepinephrine and 3-methoxy-4 hydroxyphenylglycol concentrations and severity of depression in combat posttraumatic stress disorder and major depressive disorder. Biol Psychiatry. 1998;44:56–63.

    Article  PubMed  CAS  Google Scholar 

  40. Blanchard EB, Kolb LC, Prins A, Gates S, McCoy GC. Changes in plasma norepinephrine to combat-related stimuli among Vietnam veterans with posttraumatic stress disorder. J Nerv Ment Dis. 1991;179:371–373.

    Article  PubMed  CAS  Google Scholar 

  41. Iwai M, Saheki S, Ohta Y, Shimazu T. Footshock stress accelerates carbon tetrachloride induced liver injury in rats: implication of the sympathetic nervous system. Biomed Res. 1986;7:145–154.

    CAS  Google Scholar 

  42. Kitamura H, Konno A, Morimatsu M, Jung BD, Kimura K, Saito M. Immobilization stress increases hepatic IL-6 expression in mice. Biochem Biophys Res Commun. 1997;238:707–711.

    Article  PubMed  CAS  Google Scholar 

  43. Jung BD, Kimura K, Kitamura H, et al. Norepinephrine stimulates interleukin-6 mRNA expression in primary cultured rat hepatocytes. J Biochem. 2000;127:205–209.

    PubMed  CAS  Google Scholar 

  44. Meewisse ML, Reitsma JB, de Vries GJ, Gersons BP, Olff M. Cortisol and post- traumatic stress disorder in adults: systematic review and meta-analysis. Br J Psychiatry. 2007;191:387–392.

    Article  PubMed  Google Scholar 

  45. Swain MG. Stress and the gastrointestinal tract. I. Stress and hepatic inflammation. Am. J Physiol Gastrointest Liver Physiol. 2000;279:G1135–G1138.

    PubMed  CAS  Google Scholar 

  46. Athyros VG, Kakafika AI, Karagiannis A, Mikhailidis DP. Do we need to consider inflammatory markers when we treat atherosclerotic disease? Atherosclerosis. 2008;200:1–12.

    Article  PubMed  CAS  Google Scholar 

  47. Targher G, Marra F, Marchesini G. Increased risk of cardiovascular disease in non alcoholic fatty liver disease: causal effect or epiphenomenon? Diabetologia. 2008;51:1947–1953.

    Article  PubMed  CAS  Google Scholar 

  48. Canbakan B, Senturk H, Tahan V, et al. Clinical, biochemical and histological correlations in a group of non-drinker subjects with non-alcoholic fatty liver disease. Acta Gastroenterol Belg. 2007;70:277–284.

    PubMed  CAS  Google Scholar 

  49. Wiesinger HA, Shah J, White A, et al. Liver biochemistry abnormalities in a quaternary care lipid clinic database. Ann Hepatol. 2008;7:63–66.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Sabrina Imhasly, Cédric Lehner, Annette Kocher, Verena Mast, Edith Matz, and Iris Stamm for technical and editorial support.

Author information

Authors and Affiliations

  1. Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, 3010, Bern, Switzerland

    Roland von Känel, Chiara C. Abbas, Stefan Begré & Marie-Louise Gander

  2. Swiss Cardiovascular Center Bern, Cardiovascular Prevention and Rehabilitation, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland

    Roland von Känel, Chiara C. Abbas, Hugo Saner & Jean-Paul Schmid

Authors
  1. Roland von Känel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiara C. Abbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Begré
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marie-Louise Gander
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hugo Saner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean-Paul Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roland von Känel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

von Känel, R., Abbas, C.C., Begré, S. et al. Association Between Posttraumatic Stress Disorder Following Myocardial Infarction and Liver Enzyme Levels: A Prospective Study. Dig Dis Sci 55, 2614–2623 (2010). https://doi.org/10.1007/s10620-009-1082-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-009-1082-z

Keywords

Search

Navigation