A study of stressful life events in patients with first-episode acute coronary syndrome (ACS)—a hospital-based case–control study

Abstract

Abstract Background There is considerable evidence in the literature highlighting the impact of psychological factors on the development of coronary heart disease. In India, there's a rising incidence of traumatic life events alongside coronary heart disease, yet the connection between them remains relatively understudied. Therefore, this study aims to investigate stressful life events among patients experiencing their first episode of acute coronary syndrome (ACS) and compare this with controls. Results The mean number of stressful life events (SLEs) observed was 5.07 ± 2.04 in cases and 4.35 ± 1.88 in controls, with a p-value of < 0.05. Cases had a significantly higher prevalence of medical and psychiatric morbidity than controls, with rates of 89.3% compared to 69.6% for medical issues, and 56.7% versus 24.0% for psychiatric conditions, respectively. Univariate analyses revealed a significant difference between cases and controls in the types of stressors experienced, with cases showing higher odds ratios (OR) for specific events such as Fire or Explosion (OR = 4.5), Transportation accident (OR = 3.4), and Captivity (OR = 2.3). Additionally, bivariate analyses indicated that presence of a comorbid medical illness had an OR of 5.95. At the same time, specific life events like Exposure to fire or explosion (OR = 3.35) and Transportation accidents (OR = 3.08) were more likely to occur in cases. Overall, there were significant differences in the prevalence and pattern of various types of SLEs between cases and controls. Conclusion The higher number of SLEs observed in cases compared to controls underscores their potential role in cardiac risk. While transportation accidents and fires/explosions demonstrated robust associations with ACS, the variable significance across different types of SLEs suggests a complex relationship between stressor type and cardiac outcomes. These findings highlight the need for prospective studies with larger sample sizes and further research to ascertain and quantify the role of stressful events and the risk of a cardiac event.

Keywords

• Stressful life events
• Acute Coronary Syndrome
• Case–Control