Inflammation, depressive symptomatology, and coronary artery disease

Objective: Many patients feel exhausted or depressed before the onset of an acute coronary event, but little is known about the origin of these feelin gs. We tested the hypothesis that the depressive symptomatology is associat ed with a reactivation of latent viruses and inflammation of a coronary ves sel. Methods: A blood sample was drawn and a biopsy sample was obtained fro m the coronary lesion of 15 exhausted and 15 nonexhausted patients treated with directional coronary angioplasty because of severe angina. Blood sampl es were analyzed to measure antibody titers against Chlamydia pneumoniae, c ytomegalovirus, and the cytokines interleukin (IL)-1 beta, IL-6, and tumor necrosis factor (TNF)-alpha. The biopsy sample was analyzed for the presenc e of IL-1 beta and TNF-alpha. Results: Exhausted/depressed patients had hig her antibody titers against cytomegalovirus, higher levels of C. pneumoniae immunoglobulin G, and higher levels of IL-1 beta and TNF-alpha. No associa tions between the mental state of a patient and cytokine mRNA in the biopsy sample were found. Conclusions: The findings indicate that the mental stat e of angioplasty patients is positively associated with serological markers of inflammation. It remains to be seen whether the inflammation causes fee lings of exhaustion, whether exhaustion and depression set the stage for in flammation, or whether existing feelings of exhaustion are amplified by the inflammation.