Dr Mariana Garcia: Nontraditional Risk Factors Can Affect CV Health in Younger Adults

There is a possible link between psychological distress and inflammatory markers in younger patients with a history of cardiovascular (CV) disease, specifically myocardial infarction, said Mariana Garcia, MD, cardiology fellow at Emory University.

For younger adults, psychological distress can increase levels of certain inflammatory markers of cardiovascular (CV) disease. It’s a misconception that only older adults face heart disease, explained Mariana Garcia, MD, cardiology fellow in the Academic Clinical Investigator Pathway at Emory University and member of T32, Multidisciplinary Research Training to Reduce Inequalities in Cardiovascular Health (METRIC).

A principal finding of her study, discussed in the session, “Psychological Distress and Risk of Adverse Cardiovascular Outcomes in Young and Middle-aged Survivors of Myocardial Infarction,” was a possible link between greater psychological distress and inflammatory markers among younger patients with a history of myocardial infarction (MI).


Can you speak to the specific inflammatory markers you saw and why someone in this age bracket is predisposed to worse outcomes despite being physically healthier?

There's a plethora, and there's several circulating markers of acute inflammation, but we decided to look into 3—interleukin 6, matrix metalloproteinase-9, and monocyte chemoattractant protein-1, because these have previously shown a significant association with atherosclerosis and, specifically, worse outcomes. And also very importantly, because these 3 specifically increased during acute mental stress done in the lab, which was part of our study. So that's why we specifically looked into these markers.

Now, in terms of why someone in this age bracket may be predisposed to worse outcomes, there are several things. One, we know that the prevalence of mental health disorders in the US is growing steadily. Just in 2019, an estimated 20% of US adults aged 18 or older had a diagnosed mental illness. On this regard, we know that younger patients are particularly vulnerable group because there's higher prevalence of mental health disorders compared to older adults. And we also know that young adults have benefited less from favorable cardiovascular trends and news in recent years. And so I think, overall, there's a misconception out there that heart disease is a problem faced by older adults.

On one side, we are seeing young adults increasingly be diagnosed with traditional risk factors like diabetes, hypertension, and obesity. But there's also a huge number of emerging nontraditional factors that we are learning about and having to take into consideration, especially in the young patient population—and one of them is mental health.

Why is it that psychological health has such a seemingly profound effect among persons with cardiovascular conditions?

What we think is that because this group is already at such a high risk—on top of that, you're adding inflammation, which will include a HPA axis disruption and then changes in the vascular system—that will ultimately result in more acute consequences. They already have atherosclerosis, and on top of that now you're adding psychological distress, and with all these new changes that this involves, you're putting them above a threshold for future events because they are already high risk.

Outside of clinical trial settings, in terms of the typical inflammatory markers, when it comes to specific inflammatory markers, we have to be aware that we're talking about a systemic response that doesn't just involve 1 or 2 or group of biomarkers that I can point out specifically. There's been many biomarkers that have shown relationship to cardiovascular disease overall, and we can't definitely say, “Oh, this biomarker but not the other.”

We believe that many of these effects are due to mechanisms involving systemic inflammation, as well as many other pathways, so I can't really point out to specific ones.

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