Alexithymia and Cardiac Outcome in Patients at First Acute Coronary Syndrome
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BRIEF REPORT
Alexithymia and Cardiac Outcome in Patients at First Acute Coronary Syndrome Paolo Ossola 1 & Maria Lidia Gerra 2
&
Marco Beltrani 1 & Carlo Marchesi 1
# International Society of Behavioral Medicine 2019
Abstract Background This cohort study was aimed to verify whether subjects at their first acute coronary syndrome (ACS) were more alexithymic than healthy controls (HC) and whether alexithymia can predispose patients with coronary artery disease to new major adverse cardiac events (MACE) during a 24-month follow-up period. Methods The sample included 100 HC with no history of depression or ACS and 304 never depressed patients with a first-ever ACS. A total of 266 patients completed the 2-year follow-up. Results Patients and HC reported similar Toronto Alexithymia Scale (TAS-20) scores. During the follow-up, 69 (22.69%) patients developed incident depression and 57 (18.75%) developed a new MACE. In a proportional hazard model, developing a first-ever depressive episode, but not alexithymia (hazard ratio = 1.008, 95% confidence interval = 0.984–1.033; p = 0.500), was associated with almost 3 times the risk of a recurrent cardiac event. Conclusion Incident depression, but not TAS-20 scores, represented risk factor for MACE. Keywords Coronary artery disease . Alexithymia . Incident depression . Major cardiac adverse event
Introduction Alexithymia is a multidimensional construct characterized by (1) difficulty identifying feelings (DIF), (2) difficulty communicating and describing feelings (DDF), and (3) externaloriented thinking (EOT) [1]. The Toronto Alexithymia Scale 20 items (TAS-20) is the most widely used and studied selfreport measure [2, 3]. Alexithymia, reflecting a disordered affect regulation, is thought to increase vulnerability to several medical disorders; however, epidemiological evidence regarding alexithymia as a prognostic risk factor for health problems, including coronary artery disease (CAD), remains lacking [4]. In patients with acute coronary syndrome (ACS), previous studies observed that alexithymia is significantly related with anxiety and depression [5, 6] and might be a consequence of
an acute myocardial infarction [7]. These findings suggest that TAS-20 could also measure negative affects associated with a general distress syndrome, which is induced by a lifethreatening condition rather than alexithymia itself [6]. It is still debated whether alexithymia is simply a consequence of an acute coronary disease or can predispose to new major adverse cardiac events (MACE). This study has the dual aim of evaluating whether (1) never depressed subjects at their first acute coronary syndrome have a disorder of affect regulation compared to healthy controls (consequence hypothesis) and (2) alexithymic levels, representing a stable personality trait, predicted MACE during a 24-month period of follow-up (predisposition hypothesis). Since it is possible that TAS-20 is associated with different measures of negative affects [8], we hypothesize that the relationship between alexithymia an
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