(P032) MENTAL DISORDERS AS A PREDICTOR OF ACUTE CORONARY SYNDROME: A META-ANALYSIS

Background: To estimate the incidence of acute coronary syndrome (ACS) among patients with mental disorders.

METHODS AND RESULTS: We conducted a PRISMA-2020-compliant systematic review and meta-analysis searching MEDLINE, EMBASE, PubMed from inception until February 19, 2024, for studies investigating mental disorders and incidence of ACS. Studies were included if they met the following criteria: 1) prospective or retrospective cohort, 2) measured incidence of ACS (e.g., hazard ratios), and 3) investigated any clinical mental disorder (based on DSM and ICD). The NIH Study Quality Assessment Tools were used to assess the quality of included studies. Random effects meta-analyses were performed for a quantitative synthesis.

Twenty-five full-texts met inclusion criteria with 22 048 504 participants of mean age 45.6 years. Of the included sample, 12.9% (n = 2 853 773) were diagnosed with a mental disorder at baseline, and 1.4% (n = 317,780) fulfilled criteria for an incident ACS event. Depressive (HR 1.30, 95% CI 1.16–1.46, p < 0.001, k = 7), anxiety (HR 1.52, 95% CI 1.23–1.87, p < 0.001, k = 6), sleep (HR 1.60, 95% CI 1.40–1.84, p < 0.001, k = 3) and post-traumatic stress disorders (PTSD) (HR 2.73, 95% CI 1.95–3.84, p < 0.001, k = 2) were associated with increased risk of acute myocardial infarction (AMI). Bipolar (HR 1.48, 95% CI 0.87–2.52, p = 0.15, k = 3) and psychotic disorders (HR 1.55, 95% CI 0.99–2.44, p = 0.57, k = 4) were not significantly associated with increased risk of AMI although had similar point estimates to the other mental disorders. Mental disorders were not associated with increased odds of a missed MI (OR 0.98, 95% CI 0.81–1.17, p = 0.79, k = 4).

Conclusion: Our meta-analysis found compelling evidence linking depressive, anxiety, PTSD, and sleep disorders with an increased incidence of ACS. These associations are likely mediated through genetic predispositions, traditional vascular risk factors, pro-inflammatory processes, and illness-driven-behaviours. PTSD and sleep disorders emerged as significant risk factors for ACS and AMI, highlighting the potential impact of sleep quality on cardiovascular outcomes. Although bipolar and psychotic disorders failed to reach statistical significance, they likely are associated with ACS. Integrating mental health and preventative cardiovascular care could improve outcomes and reduce the burden of ACS.