• Santosh Kumar Sinha Faculty,Deartment of Cardiology LPS Inst. of Cardiology GSVM Med.College,Kanpur
  • Gaurav Gupta registrar,Deartment of Cardiology LPS Inst. of Cardiology GSVM Med.College,Kanpur
  • Mukesh Jitendra Jha
  • Amit Goel
  • Vikas Mishra
  • Ashutosh Kumar
  • Avinash Singh
  • Ramesh Thakur


Objective: Although psycho-social factors are reported to be independently associated with myocardial ischemia in many studies, the majority of
these were done in the western population. This was conducted in India to determine the impact of psycho-social factors in subjects with the recent
acute coronary syndrome (ACS).
Methods: Patients with the first episode of ACS within 4 weeks of onset at LPS Institute of Cardiology, Kanpur, India between 2013 and 2015 were
enrolled as cases. Control was community-based individuals without coronary artery disease. Both were compared for demographic variables,
the psycho-social profile including annual income, education status, depression, stressful life events (using presumptive stressful life events scale,
i.e. PSLES), and independent predictors were determined using multiple logistic regression analysis and were computed as odds ratio (OR).
Results: Between 200 cases and 200 controls, respectively, statistically significant difference was observed in mean annual income (2.74±1.95 vs.
2.23±1.22 lac rupees; p<0.05), smoking exposure (13.93±16.17 vs. 4.88±3.10 pack years; p<0.05), mean number of stressful life events (8.18±2.57 vs.
4.14±1.63; p<0.05). Depression (48% vs. 27%; p<0.05) while education status was comparable. Further, odds of having myocardial infarction were
higher for subjects with mild-to-moderate depression (OR: 2.45), family history of heart disease (OR: 2.25), hypertensive males (OR: 1.43), and
diabetic females (OR: 1.22).
Conclusion: Psycho-social factors, particularly depression may have a significant role in the prognosis of ACS. Further systematic studies are
warranted to provide more important insights regarding the magnitude of the association between psycho-social factors and the onset of ACS.
Keywords: Coronary artery disease, Depression, Psycho-social factors, Presumptive stressful life events scale, Stressful life events.


1. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al.
Effect of potentially modifiable risk factors associated with myocardial
infarction in 52 countries (the INTERHEART study): Case-control
study. Lancet 2004;364(9438):937-52.
2. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular
diseases: Part I: General considerations, the epidemiologic transition, risk
factors, and impact of urbanization. Circulation 2001;104(22):2746-53.
3. Januzzi JL Jr, Stern TA, Pasternak RC, DeSanctis RW. The influence
of anxiety and depression on outcomes of patients with coronary artery
disease. Arch Intern Med 2000;160(13):1913-21.
4. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M,
Almahmeed WA, et al. Association of psychosocial risk factors with
risk of acute myocardial infarction in 11119 cases and 13648 controls
from 52 countries (the INTERHEART study): Case-control study.
Lancet 2004;364(9438):953-62.
5. Hemingway H, Marmot M. Evidence based cardiology: Psychosocial
factors in the etiology and prognosis of coronary heart disease. Systematic
review of prospective cohort studies. BMJ 1999;318(7196):1460-7.
6. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L.
The epidemiology, pathophysiology, and management of psychosocial
risk factors in cardiac practice: The emerging field of behavioral
cardiology. J Am Coll Cardiol 2005;45(5):637-51.
7. Kumar N, Sharma S, Mohan B, Beri A, Aslam N, Sood N, et al.
Clinical and angiographic profile of patients presenting with first acute
myocardial infarction in a tertiary care center in northern India. Indian
Heart J 2008;60(3):210-4.
8. Pais P, Fay MP, Yusuf S. Increased risk of acute myocardial infarction
associated with beedi and cigarette smoking in patients: Final report on
tobacco risks from a case-control study. Indian Heart J 2002;54:111.
9. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as
an independent risk factor for cardiovascular disease: A 26-year
follow-up of participants in the Framingham Heart Study. Circulation
10. Pais P, Pogue J, Gerstein H, Zachariah E, Savitha D, Jayprakash S, et al.
Risk factors for acute myocardial infarction in Indians: A case-control
study. Lancet 1996;348(9024):358-63.
11. Rabi DM, Edwards AL, Svenson LW, Graham MM, Knudtson ML,
Ghali WA; Alberta Provincial Project for Assessing Outcomes in
Coronary Heart Disease Investigators. Association of median household
income with burden of coronary artery disease among individuals with
diabetes. Circ Cardiovasc Qual Outcomes 2010;3(1):48-53.
12. Singh RB, Niaz MA, Ghosh S, Beegom R, Chibo H, Agarwal P,
et al. Epidemiological study of coronary artery disease and its risk
factors in an elderly Urban population of North India. J Am Coll Nutr
13. Mittleman MA, Maclure M, Nachnani M, Sherwood JB, Muller JE.
Educational attainment, anger, and the risk of triggering myocardial
infarction onset. The Determinants of Myocardial Infarction Onset
Study Investigators. Arch Intern Med 1997;157(7):769-75.
14. Wilson PW, Anderson KM, Castelli WP. Twelve-year incidence
of coronary heart disease in middle-aged adults during the era of
hypertensive therapy: The Framingham offspring study. Am J Med
15. McAndrew FT, Akande A, Turner S, Sharma Y. A cross-cultural ranking
of stressful life events in Germany, India, South Africa, and the United
States. J Cross Cult Psychol 1998;29:717.
16. Singh H, Jain S, Singh R, Gupta MS, Kishore K. Life and past one
year stressful events in coronary artery disease. Indian J Med Sci
17. Haldar A, Saha S, Mandal S, Haldar S, Mundle M, Mitra SP. Life events
as risk factors for myocardial infarction: A pilot case-control study in
Kolkata, India. J Health Popul Nutr 2005;23(2):131-6.
18. Pratt LA, Ford DE, Crum RM, Armenian HK, Gallo JJ, Eaton WW.
Depression, psychotropic medication, and risk of myocardial infarction.
Prospective data from the Baltimore ECA follow-up. Circulation
19. Wassertheil-Smoller S, Applegate WB, Berge K, Chang CJ, Davis BR,
Grimm R Jr, et al. Change in depression as a precursor of cardiovascular
events. SHEP Cooperative Research Group (Systoloc Hypertension in
the elderly). Arch Intern Med 1996;156(5):553-61.
20. Ferketich AK, Schwartzbaum JA, Frid DJ, Moeschberger ML.
Depression as an antecedent to heart disease among women and men
in the NHANES I study. National Health and Nutrition Examination
Survey. Arch Intern Med 2000;160(9):1261-8.
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How to Cite
Sinha, S. K., G. Gupta, M. J. Jha, A. Goel, V. Mishra, A. Kumar, A. Singh, and R. Thakur. “ANALYSIS OF PSYCHO-SOCIAL RISK FACTORS IN PATIENTS WITH RECENT ACUTE CORONARY SYNDROME: A CASE-CONTROL STUDY”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 9, no. 2, Mar. 2016, pp. 288-91,
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