Abstract
Cardiac patients who have social support generally have better prognosis than patients who lack social support. Several theoretical mechanisms have been proposed to explain this protective effect, including the capacity of social support to buffer the negative effects of stress. We tested this buffering effect in a study of patients hospitalized for acute coronary syndrome (ACS) in Spain. Several days after the cardiac event patients answered a questionnaire measuring stressful events during their lifetime, perceived social support around the time of the cardiac event, and depression symptoms in the past week. Results showed that stressful life events were related to depressive symptoms and worse renal function post-ACS only among patients with low perceived social support. Among patients who reported enough social support, lifetime stress was not related to depressive symptoms. No similar effects were observed on other prognostic indicators such as troponin levels or the number of obstructed arteries. These results suggest that social support can buffer the negative effects of stress on the mental and physical well-being of cardiac patients.
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Notes
To detect a small effect size (R2 = .05) under the same conditions, 212 participants would have been necessary.
Per protocol we also extracted peak myoglobin values (another cardiac biomarker similar to troponin). However, recently the hospital stopped using this biomarker for diagnostic or prognostic purposes because of the superiority of new generation high-sensitivity troponin tests. For this reason, we eventually do not report results using myoglobin (which also showed no significant relationships of interest).
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Funding
This research is part of the self-funded project “PySCA: Study on the impact of psychological factors in acute coronary syndrome” (Principal Investigator: JARH). Dafina Petrova is supported by a Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Economy, Industry, and Competitiveness. Financial support was partially provided by the Ministerio de Economía y Competitividad (Spain) (PSI2011-22954 and PSI2014-51842-R).
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Simona Wiesmaierova, Dafina Petrova, Antonio Arrebola Moreno, Andrés Catena, José Antonio Ramírez Hernández and Rocio Garcia-Retamero declare independence from the funding agencies and do not have conflicts of interest including financial interests, activities, relationships, and affiliations.
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The Ethics Committee of the University Hospital Virgen de las Nieves in Granada, Spain, provided approval for the study.
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All procedures were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Appendices
Appendix 1: Information given to participants about the objective of the study (translation from Spanish)
Dear patient:
Your doctor has raised the possibility of participating in the study “PYSCA: STUDY ON THE IMPACT OF PSYCHOLOGICAL FACTORS IN ACUTE CORONARY SYNDROME: INCIDENCE, PHYSIOPATHOLOGICAL MECHANISMS, AND INTERVENTION PROCEDURES.”
Atherosclerosis is the main and immediate cause of coronary heart disease and its clinical manifestation. We know a lot about how some factors such as smoking and diabetes affect the development of this disease, but it is also important to study the influence of psychological factors such as personality, stress, or depression.
The objective of this study is to determine how emotional and personality factors, evaluated by means of questionnaires, could influence coronary disease and/or the clinical outcomes after a coronary intervention. We also intend to determine how these psychological factors influence the development and progression of the disease. During your time in the hospital, we will evaluate your type of personality, lifestyle, and other relevant factors using standardized questionnaires. In addition to the usual analysis conducted, an additional 20 mL blood sample will be required for the analysis of inflammatory markers.
Appendix 2: Spanish version of the ENRICHD Social Support Instrument (Mitchell et al., 2003)
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Wiesmaierova, S., Petrova, D., Arrebola Moreno, A. et al. Social support buffers the negative effects of stress in cardiac patients: a cross-sectional study with acute coronary syndrome patients. J Behav Med 42, 469–479 (2019). https://doi.org/10.1007/s10865-018-9998-4
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DOI: https://doi.org/10.1007/s10865-018-9998-4