Cardiovascular Journal of Africa: Vol 29 No 4 (July/August 2018)

19 / 76

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018 AFRICA 217
18. Saez-Lorens X, Lagrutta F. The acute phase reaction during bacterial
infection and its clinical impact in children. Pediatr Infect Dis J 1993;
12: 83–87.
19. Batırel A, Gencer S, Ozer S. Enfeksiyon göstergesi olarak akut faz
reaktanları: C-reaktif protein (CRP) ve serum amiloid A (SAA). Kartal
Eğitim ve Ara ştırma Hastanesi Tıp Dergisi 2003; 14: 220–224.
20. Kılıçarslan A, Uysal A, Roach EC. Acute phase reactants. Acta Medica
2013; 2: 2–7.
21. Volanakis JE. Human C-reactive protein: expression, structure, and
function. Mol Immunol 2001; 38: 189.
22. Vanderschueren S, Deeren D, Knockaert DC, et al . Extremely elevated
C-reactive protein. Eur J Intern Med 2006; 17: 430.
23. Saadeh C. The erythrocyte sedimentation rate: old and new clinical
applications. S Afr Med J 1998; 91: 220–225.
24. Sox HC Jr, Liang MH. The erythrocyte sedimentation rate: guidelines
for rational use. Ann Intern Med 1986; 104: 515–523.
25. Aalto-Korte K, Alanko K, Kuuliala O, Jolanki R. Occupatinal meth-
acrylate and acrylate allergy from glues. Contact Dermatitis 2008; 58:
340–346.
Significant financial stress associated with 13-fold higher odds of having a heart attack
Significant financial stress is associated with a 13-fold
higher odds of having a heart attack, according to research
presented at the 18th Annual Congress of the South African
Heart Association.
‘The role of psychosocial factors in causing disease is a
neglected area of study in South Africa, perhaps because
there are so many other pressing health challenges such
as tuberculosis and HIV,’ said lead author Dr Denishan
Govender, associate lecturer, University of theWitwatersrand,
Johannesburg.
‘The INTERHEART study showed that psychosocial
factors are independently associated with acute myocardial
infarction (heart attack) in Africa but as far as we are aware
there are no other published local data,’ said last author
Professor Pravin Manga, professor of cardiology, University
of the Witwatersrand.
This study included 106 patients with acute myocardial
infarction who presented to a large public hospital in
Johannesburg. A control group of 106 patients without
cardiac disease was matched for age, gender and race. All
participants completed a questionnaire about depression,
anxiety, stress, work stress and financial stress in the previous
month. The Likert scale was used to grade the experience of
each condition.
Regarding financial stress, patients were graded with no
financial stress if they were coping financially; mild financial
stress if they were coping financially but needed added
support; moderate financial stress if they had an income
but were in financial distress; and significant financial stress
if they had no income and at times struggled to meet basic
needs. Levels of psychosocial conditions were compared
between groups and used to calculate associations with
having a heart attack.
Self-reported stress levels were common, with 96% of
heart attack patients reporting any level of stress, and 40%
reporting severe stress levels. There was a three-fold increased
risk of myocardial infarction if a patient had experienced
any level of depression (from mild to extremely severe) in the
previous month compared to those with no depression.
Both work stress and financial stress were associated
with a higher risk of acute myocardial infarction. The odds
of myocardial infarction was 5.6 times higher in patients
with moderate or severe work stress compared to those with
minimal or no stress. Patients with significant financial stress
had a 13-fold higher odds of having a myocardial infarction.
Dr Govender said: ‘Our study suggests that psychosocial
aspects are important risk factors for acute myocardial
infarction. Often patients are counselled about stress after
a heart attack but there needs to be more emphasis prior to
an event. Few doctors ask about stress, depression or anxiety
during a general physical and this should become routine
practice, like asking about smoking. Just as we provide advice
on how to quit smoking, patients need information on how
to fight stress.’
Professor Manga said: ‘There is growing recognition that
many developing countries are experiencing an increasing
prevalence of chronic diseases of lifestyle such as myocardial
infarction, and South Africa is no exception. Our study
shows that psychosocial aspects are an area of cardiovascular
prevention that deserves more attention.’
Dr David Jankelow, chairman of the SA Heart 2017
congress, commented: ‘We know that the depressed cardiac
patient is at greater risk. We as clinicians need to identify
themmuch earlier, so that they can be referred for appropriate
intervention. Cardiac rehabilitation together with counselling
and reassurance will play an important role as well.’
Professor Fausto Pinto, ESC immediate past president and
course director of the ESC programme in South Africa, said:
‘Psychosocial factors including stress at work, depression and
anxiety contribute to the risk of developing cardiovascular
disease and having a worse prognosis. European prevention
guidelines say that psychosocial risk-factor assessment
should be considered in people with, or at high risk of,
cardiovascular disease to identify possible barriers to lifestyle
change or adherence to medication.’
Source: European Society of Cardiology Press Office