Association of life stressors and suicidal ideation with long-term outcomes in patients with acute coronary syndrome and stroke

Abstract

Background

Life stressors are recognized as risk factors for the onset and prognosis of cardio-cerebrovascular events; however few studies have investigated the combined effect of life stressors and suicidal ideation (SI) on the long-term prognosis of patients with cardio- or cerebrovascular diseases.

Methods

A total of 1152 acute coronary syndrome (ACS) patients and 396 stroke patients were recruited from a tertiary university hospital in Korea at two weeks post-disease onset. Life stressors were assessed using the List of Threatening Events Questionnaire, and SI was evaluated using the “suicidal thoughts” item of the Montgomery–Åsberg Depression Rating Scale. Long-term outcomes were examined, with major adverse cardiac event (MACE) assessed over 5–12 years following ACS, and cerebro-cardiovascular events (CCVEs) assessed over 8–14 years following stroke. Cox regression models, adjusted for a range of covariates affecting life stressor, SI and long-term outcomes, were employed.

Results

In two independent cohorts, consistent associations were observed between life stressors and long-term outcomes. Life stressors were significantly associated with poor long-term composite outcomes, including MACE in ACS patients and CCVEs in stroke patients, particularly among those with SI at two weeks post-ACS or stroke. A significant interactive effect between life stressors and SI was observed only in ACS patients after adjustment for covariates.

Conclusions

Evaluating life stressors and SI during acute phase of cardio-cerebrovascular events can help identify high-risk patients for poor long-term cardio-cerebrovascular outcomes, enabling the implementation of intensive management strategies.