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Fear of Dying Tied to TNFα Levels in Cardiac Injury

Most patients experience intense or moderate fear of dying after acute coronary syndrome

THURSDAY, June 2 (HealthDay News) -- Fear of dying is seen in most patients with acute coronary syndrome (ACS) and is correlated with inflammatory responses, according to a study published online June 1 in the European Heart Journal.

Andrew Steptoe, Ph.D., from the University College London, and colleagues examined the prevalence of fear of dying, and associations with inflammatory responses during ACS, later heart rate variability (HRV), and cortisol secretion. A total of 208 patients admitted with clinically verified ACS were interviewed to assess their fear of dying. On admission, plasma tumor necrosis factor (TNF)α levels were recorded, and three weeks later the HRV and salivary cortisol levels were examined.

The investigators found that 21.7 percent of patients reported intense distress and fear of dying, and 66.1 percent reported moderate levels. Fear was found more frequently in participants who were younger, of lower socioeconomic status, or unmarried. After controlling for sociodemographic factors, clinical risk, and pain intensity, fear of dying was found to be positively correlated with admission plasma TNFα levels. After adjusting for sociodemographic and clinical factors, and medication, TNFα levels were significantly associated with reduced HRV three weeks later. Fear of dying was significantly correlated with reduced cortisol production.

"Heightened inflammation during ACS and intense distress and fear of dying may be related manifestations of an acute biobehavioral response. The association between the two indicates a linkage between emotional and inflammatory responses during ACS that is independent of background characteristics and other aspects of clinical disease," the authors write.

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