Mental disorders implicated in acute coronary syndrome

Mental disorders such as anxiety and depression, among others, appear to contribute to an increased risk of acute coronary syndrome (ACS), according to a systematic review and meta-analysis.

Researchers searched multiple online databases for observational or randomized studies in which the association between the risk of ACS and any clinical mental disorders was examined. Of the 3,616 studies initially identified, 25 full-text articles met the inclusion criteria.

The total study population comprised 22,048,504 participants (median age 48 years, 59.1 percent male). The most common mental disorders were anxiety (nine studies), depressive symptoms (10 studies), and substance use (four studies). ACS outcomes included ST-elevation myocardial infarction (STEMI), non-STEMI, any ACS, missed MI, and reinfarction.

Pooled data showed that the risk of ACS was significantly elevated in the presence of depression (hazard ratio [HR], 1.40, 95 percent confidence interval [CI], 1.11–1.78; p=0.01; GRADE certainty very low), anxiety (HR, 1.63, 95 percent CI, 1.40–1.89; p<0.001; GRADE certainty low), sleep disorder (HR, 1.60, 95 percent CI, 1.22–2.10; p<0.001; GRADE certainty low), and post-traumatic stress disorder (PTSD) (HR, 2.73, 95 percent CI, 1.94–3.84; p<0.001; GRADE certainty moderate).

No associations were observed for bipolar (HR, 1.48, 95 percent CI, 0.47–4.61; p=0.28; GRADE certainty very low) and psychotic (HR, 0.97, 95 percent CI, 0.01–178.30; p=0.06; GRADE certainty very low) disorders.

The findings underscore the importance of integrating mental health screening and management into cardiovascular care to improve outcomes and reduce the burden of ACS among individuals with mental health disorders. More studies are needed to elucidate the underlying mechanism and generate evidence that can guide targeted interventions.