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cytokines, depression, fatigue, myocardial infarction recurrence, sleep



  1. Abel, Willie M. PhD
  2. Scanlan, Lauren N. PhDc
  3. Horne, Carolyn E. PhD
  4. Crane, Patricia B. PhD


Background: As recurrent myocardial infarctions (MIRs) constitute almost a third of the annual incidence of myocardial infarction, identifying the traditional and novel variables related to MIR is important.


Objective: The aim of this study was to examine modifiable cardiac risks, adiposity, symptoms associated with inflammation (fatigue, depression, sleep) and inflammatory cytokines, and MIR by sex and race.


Methods: Using a cross-sectional descriptive design, we recruited a convenience sample of adults (N = 156) discharged with first myocardial infarction or had MIR in the last 3 to 7 years. Surveys measured demographics, cardiac risk factors, depression, sleep, and fatigue. Anthropometric measures and cytokines tumor necrosis factor-[alpha], interleukin-6, and high-sensitivity C-reactive protein (hsCRP) were obtained. A maximum likelihood regression was calculated to predict MIR.


Results: The sample included 57% male and 30% Black participants, and the mean (SD) age was 65 (12) years. The hsCRP was the only cytokine related to symptoms: fatigue (r = 0.309, P < .001) and depression (r = 0.255, P = .002). An MIR was not associated with race despite White participants reporting better sleep (t146 = -3.25, P = .002), lower body mass index (t154 = -3.49, P = .001), and fewer modifiable risk factors (t152 = -2.05, P = .04). An MIR was associated with being male, higher hsCRP and tumor necrosis factor-[alpha] levels (P < .001), and higher inflammatory symptoms of fatigue (P = .04), depression (P = .01), and poor sleep (P < .001).


Conclusion: Further examination of biomarkers to understand the mechanisms associated with inflammatory symptoms of fatigue, depression, and poor sleep and MIR is needed.