Comparative analysis of subclinical anxiety-depressive syndrome in STEMI patients before and during active hostilities in Kharkiv Region, Ukraine

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O. V. Petyunina
M. P. Kopytsya
I. R. Vyshnevska
P. O. Petiunin


The aim – to assess subclinical emotional distress in patients with ST-Elevation Myocardial Infarction (STEMI) before and during the ongoing conflict in the Kharkiv Region. 
Materials and methods. The study encompassed 242 patients exhibiting subclinical emotional distress and hospitalized with STEMI at «L.T. Malaya TNI of NAMSU» before active conflict, compared with 65 patients during the conflict. Adherence to ethical standards was ensured, in line with the 1964 Helsinki Declaration, and the protocol received approval from the local ethics committee (Protocol № 8, dated 29.08.2016, and Protocol № 4, dated 12.05.2022). Participants completed the DASS-21 questionnaire, reflecting their emotional state 10–14 days prior, and received STEMI treatment as per current guidelines.
Results. We showed that anxiety more frequent appeared during the active hostilities (p=0.0218). Depression had the influence on excessive smoking (p=0.0199), LV EF decrease (p=0.0057), LDL-C increase (p=0.0393). Anxiety and stress intrude into hypertension frequency (p=0.0171, p=0.0489) consequently as well as anxiety – on LDL-C increase (p=0.0068). All data of subclinical emotional distress during active hostilities associate with the frequency of smoking increase: p=0.0422 for depression, p=0.0275 for anxiety and p=0.0199 for stress. Depression associates with LVEF decrease (p=0.0267), the leucocytes count increase (p=0.0467), high frequency of hypertension (p=0.0410). Anxiety associates with higher heart rate (p=0.0277), depression and stress – with younger age (p=0.0369).
Conclusions. Our research demonstrates close associations between the data of subclinical emotional distress both in patients with STEMI before and during the active hostilities in Kharkiv Region. Data were assessed with DASS-21 questionnaire on 10 –14 day prior the event. These results should be undertaken during general practitioner’s appointment to prevent further cardiovascular event.

Article Details


STEMI, subclinical emotional distress, active hostilities in Kharkiv Region


Carney RM, Freedland KE. Depression and coronary heart disease. Nat Rev Cardiol. 2017 Mar;14(3):145-55.

Tatishvili S, Kandashvili T, Gordeladze D. Importance of Depressive Symptoms in Patients With Coronary Heart Disease – Review Article. Curr Probl Cardiol. 2023 Jun;48(6):101646.

Vaccarino V, Badimon L, Bremner JD, Cenko E, Cubedo J, Dorobantu M, Duncker DJ, Koller A, Manfrini O, Milicic D, Padro T, Pries AR, Quyyumi AA, Tousoulis D, Trifunovic D, Vasiljevic Z, de Wit C, Bugiardini R; ESC Scientific Document Group Reviewers. Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation. Eur Heart J. 2020 May 1;41(17):1687-96.

Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, Freedland KE, Jaffe AS, Leifheit-Limson EC, Sheps DS, Vaccarino V, Wulsin L; American Heart Association Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014 Mar 25;129(12):1350-69.

Penninx BW. Depression and cardiovascular disease: Epidemiological evidence on their linking mechanisms. Neurosci Biobehav Rev. 2017 Mar;74(Pt B):277-86.

Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol. 2010 Jun 29;56(1):38-46. 10.1016/j.jacc.2010.03.034.

Wen Y, Yang Y, Shen J, Luo S. Anxiety and prognosis of patients with myocardial infarction: A meta-analysis. Clin Cardiol. 2021 Jun;44(6):761-70.

Tully PJ, Cosh S, Pedersen S. Cardiovascular Manifestations of Panic and Anxiety. In: Govoni, S., Politi, P., Vanoli, E. (eds) Brain and Heart Dynamics. Springer; 2020. Cham.

Kosmas N, Zapantiotis D, Kitridis D, Kiouri E, Rallidis L. S. Gradually increased stress levels in the days leading to an acute myocardial infarction, detected by a new biomarker-based approach. Eur Heart J. 2022;43(Suppl_2): ehac544-1275.

Ibanez B, James S, Agewall S. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77.

Lovibond SH, Lovibond PF. Depression Anxiety Stress Scales (DASS-21, DASS-42) [Database record]. APA PsycTests;1995.

Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-88. .

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104.

Buse JB, Wexler DJ, Tsapas A, Rossing P, Mingrone G, Mathieu C, D' Alessio DA, Davies MJ. 2019 Update to Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020 Feb;43(2):487-93.

Mahase E. Living in a war zone increases heart disease and stroke risk years after conflict ends, study finds. BMJ. 2019 May 29;365:12367.

Bagherian-Sararoudi R, Gilani B, Bahrami Ehsan H, Sanei H. Relationship between left ventricular ejection fraction and depression following myocardial infarction: an original article. ARYA Atheroscler. 2013 Jan;9(1):16-21.

AbuRuz ME. Patients with ST-segment elevation myocardial infarction: moderating effect of perceived control on the relationship between depression and in-hospital complications. BMC Cardiovasc Disord. 2019 Jun 13;19(1):143.

Pelletier R, Lavoie KL, Bacon SL, Thanassoulis G, Khan NA, Pilote L; GENESIS-PRAXY Investigators. Depression and disease severity in patients with premature acute coronary syndrome. Am J Med. 2014 Jan;127(1):87-93.e1-2.

Meisel SR, Kutz I, Dayan KI, Pauzner H, Chetboun I, Arbel Y, David D. Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet. 1991 Sep 14;338(8768):660-1.

Lorem GF, Næss ET, Løchen ML, Lillevoll K, Molund EM, Rösner A, Lindkvist S, Schirmer H. Post-traumatic stress disorder among heart disease patients: a clinical follow-up of individuals with myocardial infarction in the Tromsø Study. BMC Psychiatry. 2023 Dec 12;23(1):936.

Singh N, Kumar A, Datta R, Bhardwaj P, Aggarwal N, Chadha DS, Singh SP, Sharma P, Barwad P, Gupta H. Analysis of ST-elevation myocardial infarction occurring in soldiers during strenous military training. Med J Armed Forces India. 2021 Oct;77(4):413-418.

Crum-Cianflone NF, Bagnell ME, Schaller E, Boyko EJ, Smith B, Maynard C, Ulmer CS, Vernalis M, Smith TC. Impact of combat deployment and posttraumatic stress disorder on newly reported coronary heart disease among US active duty and reserve forces. Circulation. 2014 May 6;129(18):1813-20.

Al-Makhamreh H, Alkhulaifat D, Al-Ani A, Mafrachi B, Saadeh A, Al-Ani H, Bani Hani A, AlRyalat SA. The Impact of War-Related Stress on Coronary Artery Disease Severity in War Survivors: A SYNTAX Study. Int J Environ Res Public Health. 2021 Mar 21;18(6):3233.

Boos CJ, De Villiers N, Dyball D, McConnell A, Bennett AN. The Relationship between Military Combat and Cardiovascular Risk: A Systematic Review and Meta-Analysis. Int J Vasc Med. 2019 Dec 22;2019:9849465.

Wawrzyniak AJ, Bekkouche NS, Krantz DS. Acute Behavioral and Psychosocial Triggers of Myocardial Infarction. In: Waldstein SR, Kop WJ, Suarez EC, Lovallo WR, Katzel LI. eds. Handbook of Cardiovascular Behavioral Medicine. Springer, New York; 2022. P. 1131-48.

Mirić D, Culić V, Giunio L, Bozić I, Fabijanić D, Glavas D. Epidemioloske osobitosti bolesnika s infarktom miokarda na splitskome podrucju tijekom domovinskog rata [Epidemiologic characteristics of patients with myocardial infarct in the region of Split during the period of war in the homeland]. Lijec Vjesn. 2002 Aug-Sep;124(8-9):243-6. Croatian.

Manoj MT, Joseph KA, Vijayaraghavan G. Association of depression, anxiety, and stress with myocardial infarction: A case-control study. J Clin Prev Cardiol 2018;7(3):86-92.

Benninghoven D, Kaduk A, Wiegand U, Specht T, Kunzendorf S, Jantschek G. Influence of anxiety on the course of heart disease after acute myocardial infarction – risk factor or protective function? Psychother Psychosom. 2006;75(1):56-61.

Li P, Lu X, Kranis M, Wu F, Teng C, Cai P, Hashmath Z, Wang B. The association between anxiety disorders and in-hospital outcomes in patients with myocardial infarction. Clin Cardiol. 2020 Jun;43(6):622-9.

Ciric-Zdravkovic S V, Zikic OV, Stanojevic DM, Petrovic-Nagorni SM. Anxiety in patients with acute coronary syndromes. Eur J Psychiat. 2014;28(3):165-71.

Mal K, Awan ID, Ram J, Shaukat F. Depression and Anxiety as a Risk Factor for Myocardial Infarction. Cureus. 2019 Nov 3;11(11):e6064.

Santos H, Santos M, Paula SB, Figueiredo M, Almeida I, Miranda H, Chin J, Sá C, Neto M, Almeida S, Sousa C, Almeida L. Acute coronary syndrome and stress: Is there a relationship? Rev Port Cardiol. 2023 Jan;42(1):9-17. English, Portuguese.

Gupta MD, Kunal S, Jha M, Girish MP, Mishra P, Shukla M, Bundela N, Batra V, Bansal A, Mukhopadhyay S, Yusuf J. Psychosocial stress and well-being in patients presenting with acute myocardial infarction in a tertiary care center. Indian Heart J. 2023 Jul-Aug;75(4):298-303.

Singh D, Guest PC, Dobrowolny H, Vasilevska V, Meyer-Lotz G, Bernstein HG, Borucki K, Neyazi A, Bogerts B, Jacobs R, Steiner J. Changes in leukocytes and CRP in different stages of major depression. J Neuroinflammation. 2022 Apr 4;19(1):74.

Núñez J, Fácila L, Llàcer A, Sanchís J, Bodí V, Bertomeu V, Sanjuán R, Blasco ML, Consuegra L, Bosch MJ, Chorro FJ. Valor pronóstico del recuento leucocitario en el infarto agudo de miocardio: mortalidad a largo plazo [Prognostic value of white blood cell count in acute myocardial infarction: long-term mortality]. Rev Esp Cardiol. 2005 Jun;58(6):631-9.

Han AL. Association between lipid ratio and depression: a cross-sectional study. Sci Rep. 2022 Apr 13;12(1):6190.

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