Clinical correlates of complicated grief among individuals with acute coronary syndromes.

OBJECTIVE: The study aimed at exploring bereavement and complicated grief (CG) symptoms among subjects without a history of coronary heart disease (CHD) at the time of a first acute coronary syndrome (ACS) and to evaluate the relationship of CG symptoms and ACS. METHOD: Overall, 149 subjects with ACS (namely, acute myocardial infarct with or without ST-segment elevation or unstable angina), with no previous history of CHD, admitted to three cardiac intensive care units were included and evaluated by the Structured Clinical Interview for Complicated Grief (SCI-CG), Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and the 36-item Short-Form Health Survey (MOS-SF-36). RESULTS: Of the total sample of 149 subjects with ACS, 118 (79.2%) met criteria for DSM-5 persistent complex bereavement disorder. Among these, subjects who lost a partner, child, or sibling were older (P=0.008), less likely to be working (P=0.032), and more likely to be suffering from hypertension (P=0.021), returned higher scores on the SCI-CG (P=0.001) and developed the index ACS more frequently between 12 and 48 months after the death than those who lost a parent or another relative (P≤0.0001). The occurrence of ACS 12-48 months (P=0.019) after the loss was positively correlated with SCI-CG scores. An inverse relationship with SCI-CG scores was observed for patients who experienced ACS more than 48 months after the loss (P=0.005). The SCI-CG scores significantly predicted lower scores on the "general health" domain of MOS-SF-36 (P=0.030), as well as lower scores on "emotional well-being" domain (P=0.010). CONCLUSION: A great proportion of subjects with ACS report the loss of a loved one. Among these, the loss of a close relative and the severity of CG symptoms are associated with poorer health status. Our data corroborate previous data indicating a strong relationship between CG symptoms and severe cardiac problems.

Influence of depression and anxiety on circulating endothelial progenitor cells in patients with acute coronary syndromes.

OBJECTIVES: Circulating endothelial progenitor cells (EPCs) are related to endothelial function and progression of coronary artery disease. There is evidence of decreased numbers of circulating EPCs in patients with a current episode of major depression. We investigated the relationships between the level of circulating EPCs and depression and anxiety in patients with acute coronary syndrome (ACS). METHODS: Patients with ACS admitted to three Cardiology Intensive Care Units were evaluated by the SCID-I to determine the presence of lifetime and/or current mood and anxiety disorders according to DSM-IV criteria. The EPCs were defined as CD133(+) CD34(+) KDR(+) and evaluated by flow cytometry. All patients underwent standardized cardiological and psychopathological evaluations. Parametric and nonparametric statistical tests were performed where appropriate. RESULTS: Out of 111 ACS patients, 57 were found to have a DSM-IV lifetime or current mood or anxiety disorder at the time of the inclusion in the study. The ACS group with mood or anxiety disorders showed a significant decrease in circulating EPC number compared with ACS patients without affective disorders. In addition, EPC levels correlated negatively with severity of depression and anxiety at index ACS episode. CONCLUSIONS: The current study indicates that EPCs circulate in decreased numbers in ACS patients with depression or anxiety and, therefore, contribute to explore new perspectives in the pathophysiology of the association between cardiovascular disorders and affective disorders.

Impact of depression on circulating endothelial progenitor cells in patients with acute coronary syndromes: a pilot study.

AIMS: Depression has been identified as a risk factor for an adverse prognosis and reduced survival in patients with acute coronary syndrome (ACS). The number of endothelial progenitor cells (EPCs) is an independent predictor of clinical outcomes in patients with ACS. The aim of this study was to evaluate the impact of depression on EPC levels in patients with ACS. METHODS: Out of 74 ACS patients [23 non-ST-segment elevation myocardial infarction (NSTEMI), 48 STEMI], 36 had a diagnosis of major depressive episode (MDE) according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria at the time of the inclusion in the study. Control groups were as follows: 15 healthy individuals and 18 patients with current MDE without a history of cardiovascular diseases. EPCs were defined as CD34CD133KDR and evaluated by flow cytometry. All patients underwent standardized cardiological and psychopathological evaluations. Parametric and nonparametric statistical tests were performed wherever appropriate. RESULTS: ACS patients with MDE showed a significant decrease in circulating EPC number compared with ACS patients without MDE (P < 0.001). The ACS study population was then subdivided into STEMI and NSTEMI groups, and within each group patients with MDE again showed a significant decrease in circulating CD34CD133KDR EPCs compared with others (P <0.001). CONCLUSION: We showed that ACS patients with MDE have a reduced number of circulating CD34CD133KDR cells compared with ACS patients without MDE, suggesting that the presence of MDE reduces the response of bone marrow to acute ischemic events. Considering the reparative role of EPCs in ACS patients, we propose that patients with MDE might be protected less than patients without MDE.

Safety of MF-59 adjuvanted vaccine for pandemic influenza: results of the vaccination campaign in an Italian health district.

BACKGROUND: The occurrence of pandemic H1N1 influenza in 2009 led health authorities to promptly start massive vaccination campaigns. Due to the need of shortening time for development and approval, the pandemic vaccine was prepared by mock-up strategy, and limited safety data were available upon starting vaccine administration. AIMS: To determine the frequencies and clinical features of adverse events (AEs) observed in a population of subjects of an Italian health district receiving pandemic vaccination. The risk for the development of at least one AE was calculated for patients receiving H1N1 vaccine only or H1N1+seasonal vaccine. METHODS: This prospective observational study was performed on the population of La Spezia Health District scheduled to receive pandemic MF-59-adjuvanted H1N1 vaccine. Subjects were enrolled at the time of vaccine administration and followed up at least for 6 months. The study population was stratified in two subgroups defined by administration of H1N1 vaccine only or H1N1+seasonal vaccine. AEs were recorded during the first hour following vaccine administration (early AEs) and through periodic telephonic interviews (delayed AEs). RESULTS: An overall number of 506 subjects receiving pandemic vaccine were enrolled (H1N1 only: 131 subjects; H1N1+seasonal: 375 subjects). 233 AEs occurred throughout the study period. Among them, 211 were resolved, while 22 were ongoing at the last available follow-up. Adjusted incidence rate ratio (IRR) for the development of at least one AE was 1.14 (0.77-1.69) for H1N1 only group vs H1N1+seasonal group. Patients with a nervous system AE were more frequent in the H1N1+seasonal group (adjusted IRR: 2.33; 95%CI: 1.04-5.23). Only two cases of ischemic stroke, both in the H1N1+seasonal vaccine group, occurred in patients with cardiovascular risk factors, were classified as serious AEs. CONCLUSIONS: In the present study, the MF59-adjuvanted H1N1 vaccine was generally well tolerated. AEs were usually transient and mild to moderate in intensity. Our findings support the validity of mock-up strategy for rapid development of a safe vaccine in the emergency of a pandemic influenza.