Evaluation of plasma levels of C-reactive protein, interleukins and markers of subclinical atherosclerosis in patients with refractory unipolar depression or bipolar affective disorder

Abstract

Major depression (MD) increases up to six times the mortality rate from acute myocardial infarction (AMI) in patients with known coronary artery disease and up to 4.5 times the risk of major primary cardiovascular (CV) events such as fatal and non-fatal AMI. Increased plasma concentrations of ACTH and cortisol, inflammatory cytokine as interleukins IL-1, Il-6, and tumor necrosis factor a (TNF a ), cell adhesion molecules and acute phase proteins such as C reactive protein were also found suggesting that MD is followed by an intense inflammatory response. Bipolar disorder (BD) presents even greater inflammatory profile and CV mortality almost doubles the aged matched general population. Taken together, these findings suggest that inflammatory response in MD and BD could play an important role in the pathogenesis of cardiovascular events within these patients once inflammation is epiphenomena of coronary disease. Therefore, the aim of the present study is to access high sensitive C reactive protein, cytokines (IL-1, IL-6 and TNF ±), lipid profile and risk factors to coronary artery disease in patients with refractory MD or BD and compare to age matched controls. We will also examine subclinical atherosclerosis studying calcium score obtained by ultrafast thorax computer tomography, carotid intimal medial thickness, and ankle/brachial index. We will access genes that play a role in MD and BD as 5-HTTLPR (a serotonin transporter gene and its polymorphism - long and short) and BDNF (brain derived neurotrophic factor Val66Met) and other selected genes polymorphisms involved in inflammatory response. We hypothesize that MD or BD patients may present more subclinical atherosclerosis than age matched controls and primary prevention should be anticipated. (AU)