Psychosocial risk factors for recurrent acute coronary catastrophe in patients with coronary heart disease: a view through the prism of alexithymia


DOI: https://dx.doi.org/10.18565/therapy.2021.3.43-52

Kodochigova A.I., Kirichuk V.F., Psanukova D.Z., Dzheyranova M.O., Bogdanova T.M., Sinkeev M.S., Olenko E.S.

V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia
Abstract. The aim of the study was to analyze the features of the psychoemotional status of male patients with coronary heart disease (CHD) after a heart attack and clinically healthy men in terms of the presence or absence of manifestations of alexithymia.
Material and methods. To achieve this goal, 135 men (average age – 46,7 (43,9; 51,6) years) were examined: 69 CHD patients who had suffered a heart attack were included in the main group and 66 clinically healthy men – in the control group. The study of the psychological characteristics of a person was carried out using various survey methods. All the observed persons were divided into three subgroups: I subgroup consisted of persons without signs of alexithymia; II subgroup – persons who fell into the «risk zone»; III subgroup – carriers of alexithymia.
Results. It was found that a greater degree of severity of emotional-negative personality traits, as independent risk factors for the development and complicated course of CHD, was observed in men (from both groups) with clear clinical signs of alexithymia and a tendency to its development. In patients with CHD, who are carriers of alexithymia, the severity of anxiety-depressive disorders is carefully hidden and may not be realized, which makes these negative psychological features more dangerous than when they are clearly manifested. The individuals of the main and control groups, who were in the «risk zone» of developing alexithymia, had similar psychological traits: a tendency to suppress emotions, including aggression. The presence of alexithymia or a tendency to develop it reduced the resistance to the action of stress agents in all males (in both groups) under our supervision.
Conclusion. The risk of recurrent coronary catastrophe is higher in patients with obvious signs of alexithymia or who are in the «risk zone» of its development, compared with those who are not carriers of alexithymia. Thus, to increase the effectiveness of primary and secondary cardiovascular prevention, it is advisable to include methods of psychological and pharmacological correction of the changes detected in them.
Keywords: coronary heart disease, myocardial infarction, myocardial revascularization, alexithymia, anxiety, clinically healthy individuals
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Literature


  1. Безверхов А.А., Ищенко О.Ю. Динамика смертности от сердечно-сосудистых заболеваний за период 2015–2019 гг. Norwegian Journal of Development of the International Science. 2021; 54-2: 35–38. [Bezverkhov A., Ishchenko O. Dynamics of mortality from cardiovascular diseases for the period 2015–2019. Norwegian Journal of Development of the International Science. 2021; 54-2: 35–38 (In Russ.)]. doi: https://dx.doi.org/10.24412/3453-9875-2021-54-2-35-38.

  2. Каюмова М.М., Гакова Е.И., Сенаторова О.В. Эпидемиологические аспекты распространенности ишемической болезни сердца в открытой городской популяции: гендерные различия. Сибирский медицинский журнал (г. Томск). 2019; 2: 146–151. [Kayumova M.M., Gakova E.I., Senatorova O.V. Epidemiological aspects of the prevalence of coronary heart disease in an open urban population: Gender differences. Sibirskiy meditsinskiy zhurnal (g. Tomsk) = Siberian medical journal (Tomsk). 2019; 2: 146–151 (In Russ.)]. doi: https://dx.doi.org/10.29001/2073-8552-2019-34-2-146-151.

  3. Жмуров Д.В., Парфентева М.А., Семенова Ю.В. Ишемическая болезнь сердца. Colloquium-journal. 2020; 29-1: 32–37. [Zhmurov D.V., Parfenteva M.A., Semenova Y.V. Coronary heart disease. Colloquium-journal. 2020; 29-1: 32–37 (In Russ.)]. doi: https://dx.doi.org/10.24411/2520-6990-2020-12227.

  4. Великанов А.А., Столярова А.А., Круглова Н.Е., Демченко Е.А. Особенности психоэмоциональной сферы пациентов с ишемической болезнью сердца: обзор исследований. Психология. Психофизиология. 2020; 1: 23–33. [Velikanov A.A., Stoljarova A.A., Kruglova N.E., Demchenko E.A. Psychoemotional features in patients with coronary heart disease: Literature review. Psikhologiya. Psikhofiziologiya = Psychology. Psychophysiology. 2020; 1: 23–33 (In Russ.)]. doi: https://dx.doi.org/10.14529/jpps200103.

  5. Кодочигова А.И., Киричук В.Ф., Синькеев М.С. с соавт. Особенности психологического статуса пациентов с различными формами ишемической болезни сердца. Саратовский научно-медицинский журнал. 2019; 3: 744–749. [Kodochigova A.I., Kirichuk V.F., Sinkeev M.S. et al. Distinctive features of psychological status for patients with various forms of coronary heart disease. Saratovskiy nauchno-meditsinskiy zhurnal = Saratov journal of medical scientific research. 2019; 3: 744–749 (In Russ.)].

  6. Гарганеева Н.П., Корнетов Н.А., Белокрылова М.Ф. Психосоциальные факторы, тревожные и депрессивные расстройства у пациентов с ишемической болезнью сердца: проблемы коморбидности и прогнозирования. Российский кардиологический журнал. 2020; 9: 26–32. [Garganeeva N.P., Kornetov N.A., Belokrylova M.F. Psychosocial factors, anxiety and depressive disorders in patients with coronary artery disease: Problems of comorbidity and prognosis. Rossiyskiy kardiologicheskiy zhurnal = Russian journal of cardiology. 2020; 9: 26–32 (In Russ.)]. doi: https://dx.doi.org/10.15829/1560-4071-2020-404.

  7. Mahmood S., Hassan S., Tabraze M. Prevalence and predictors of depression amongst hypertensive individuals in Karachi, Pakistan. Cureus. 2017; 9(6); 1397. doi: 10.7759/cureus.1397.

  8. Pizzi C., Manzoli L., Mancini S., Bedetti G. Autonomic nervous system, inflammation and preclinical carotid atherosclerosis in depressed subjects with coronary risk factors. Atherosclerosis. 2010; 212(1): 292–98. doi: 10.1016/j.atherosclerosis.2010.04.038.

  9. Брель Е.Ю. Алекситимия в структуре «практически здоровой» личности. Сибирский психологический журнал. 2018; 67: 89–101. [Brel E.Yu. Alexithymia in the structure of «apparently healthy» personality. Sibirskiy psikhologicheskiy zhurnal = Siberian psychological journal. 2018; 67: 89–101 (In Russ.)]. doi: https://dx.doi.org/10.17223/17267080/67/7.

  10. Grabe H.J., Schwahn C., Barnow S. et al. Alexithymia, hypertension, and subclinical atherosclerosis in the general population. J Psychosom Res. 2010; 68(2): 139–47. doi: 10.1016/j.jpsychores.2009.07.015.

  11. Северова Е.А., Охапкин А.С., Даутова М.А., Реутова Е.В. Алекситимия как феномен, объединяющий некоторые аспекты психической и психосоматической патологий. Вестник Смоленской государственной медицинской академии. 2016; 4: 126–133. [Severova E.A., Okhapkin A.S., Dautova M.A., Reutova E.V. Alexithymia as a phenomenon, combining some aspects of mental and psychosomatic disorders. Vestnik Smolenskoy gosudarstvennoy meditsinskoy akademii = Bulletin of the Smolensk State Medical Academy. 2016; 4: 126–133 (In Russ.)].

  12. Алексеевич Г.Ю., Родиков М.В., Марченко А.В. с соавт. Анализ послеоперационной когнитивной дисфункции при различных методах операции аортокоронарного шунтирования. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017; 7: 16–20. [Alekseevich G.Yu., Rodikov M.V., Marchenko A.V. et al. An analysis of postoperative cognitive dysfunction in different methods of coronary artery bypass. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = Journal of neurology and psychiatry named after S.S. Korsakov. 2017; 7: 16–20 (In Russ.)]. doi: https://dx.doi.org/10.17116/jnevro20171177116-20.

  13. Neumann F., Sousa-Uva M., Ahlsson A. et al. Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019; 40(2): 87–165. doi: 10.1093/eurheartj/ehy394.

  14. Ajtahed S., Rezapour T., Etemadi S. et al. Efficacy of neurocognitive rehabilitation after coronary artery bypass graft surgery in improving quality of life: An interventional trial. Front Psychol. 2019; 10: 1759. doi: 10.3389/fpsyg.2019.01759.

  15. Sadeghi M., Hashemi M., Sararoudi R.B. et al. Demographic and psychological predictors of recovery from coronary artery bypass graft. Journal of education and health promotion. J Educ Health Promot. 2017; 6: 92. doi: 10.4103/jehp.jehp_154_16.

  16. Stenman M., Holzmann M.J., Sartipy U. Association between preoperative depression and long-term survival following coronary artery bypass surgery – A systematic review and meta-analysis. Int J Cardiol. 2016; 222: 462–66. doi: 10.1016/j.ijcard.2016.07.216.

  17. Acıkel M. Evaluation of depression and anxiety in coronary artery bypass surgery patients: A prospective clinical study. Braz J Cardiovasc Surg. 2019; 34(4): 389–95. doi: 10.21470/1678-9741-2018-0426.

  18. Клинические рекомендации. Стабильная ишемическая болезнь сердца. Российское кардиологическое общество при участии Национального общества по изучению атеросклероза, Национального общества по атеротромбозу, Ассоциации сердечно-сосудистых хирургов России. 2020. Доступ: http://cr.rosminzdrav.ru/schema/155_1 (дата обращения – 01.03.2021). [Clinical guidelines. Stable coronary artery disease. Russian Society of Cardiology with the participation of National Society for the Study of Atherosclerosis, National Society for Atherothrombosis, Association of Cardiovascular Surgeons of Russia. 2020. Available at: http://cr.rosminzdrav.ru/schema/155_1 (date of access – 01.03.2021) (In Russ.)].

  19. Knuuti J., Wijns W., Saraste A. et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407–77. doi: 10.1093/eurheartj/ehz425.

  20. Martinez-Sanchez F. The Spanish version of the Toronto Alexithymia Scale (TAS-20). Clinica y Salud. 1996; 7: 19–32.

  21. Субботин С.В. Устойчивость к психическому стрессу как характеристика метаиндвидуальности учителя. Дис. ... канд. психол. наук. Пермь. 1993; 152 с. [Subbotin S.V. Resistance to mental stress as a characteristic of the teacher’s meta-individuality. Dissertation of the candidate of psychological sciences. Perm. 1993; 152 pp. (In Russ.)].

  22. Ханин Ю.Л. Краткое руководство к применению шкалы реактивной и личностной тревожности Ч.Д. Спилбергера. Л.: ЛНИИ ФК. 1976; 18 с. [Khanin Yu.L. A brief guide to the use of the scale of reactive and personal anxiety Spielberger Ch.D. Leningrad: LNII FK. 1976; 18 pp. (In Russ.)].

  23. Зайцев В.П. Вариант психологического теста Мini-Mult. Психологический журнал. 1981; 3: 118–123. [Zaytsev V.P. Variant of psychological test Mini-Mult. Psikhologicheskiy zhurnal = Journal of psychology. 1981; 3: 118–123 (In Russ.)].

  24. Зайцев В.П., Айвазян Т.А. Психологический тест СМОЛ: применение в клинической медицине (аналитический обзор). Терапевтический архив. 2008; 4: 89–92. [Zaytsev V.P., Aivazyan T.A. Psychological AMPI test: application in clinical medicine (analytical review). Terapevticheskiy arkhiv = Therapeutic archive. 2008; 4: 89–92 (In Russ.)].

  25. Еремеев А.Г. Ишемическая болезнь сердца с позиции психосоматической медицины (теоретический аспект). Молодой ученый. 2019; 49: 248–253. [Eremeev A.G. Ischemic heart disease from the standpoint of psychosomatic medicine (theoretical aspect). Molodoy uchenyy = Young scientist. 2019; 49: 248–253 (In Russ.)].

  26. Березин Ф.Б., Мирошников М.П., Соколова Е.Д. Методика многостороннего исследования личности. М.: Фолиум. 1994; 176 с. [Berezin F.B., Miroshnikov M.P., Sokolova E.D. Methods of multilateral personality research. Moscow: Folium. 1994; 176 pp. (In Russ.)].

  27. Собчик Л.Н. СМИЛ (ММРI). Стандартизированный многофакторный метод исследования личности. СПб: Речь. 2006; 224 с. [Sobchik L.N. ММРI: Standardized multivariate personality research method. Saint Petersburg: Rech = Speech. 2006; 224 pp. (In Russ.)].

  28. Смулевич А.Б. Психосоматические расстройства. Руководство для практических врачей. Под ред. акад. РАН А.Б. Смулевича. М.: МЕДпресс-информ. 2019; 496 с. [Smulevich A.B. Psychosomatic disorders. A guide for practitioners. Ed. by acad. of RAS Smulevich A.B. Moscow: MEDpress-inform. 2019; 496 pp. (In Russ.)].

  29. Тарасенко А.В. Агрессия и пути ее предупреждения. Молодой ученый. 2017; 12: 196–199. [Tarasenko A.V. Aggression and ways to prevent it. Young scientist. 2017; 12: 196–199 (In Russ.)].

  30. Смулевич А.Б., Дубницкая Э.Б., Воронова Е.И. К проблеме распознавания психосоматических расстройств в общемедицинской практике. Психические расстройства в общей медицине. 2017; 3–4: 4–10. [Smulevich A.B., Dubnitskaya E.B., Voronova E.I. To the problem of recognition of psychosomatic disorders in general medical practice. Psikhicheskiye rasstroystva v obshchey meditsine = Mental disorders in general medicine. 2017; 3–4: 4–10 (In Russ.)].


About the Autors

Anna I. Kodochigova, MD, professor, professor of the Department of therapy, gastroenterology and pulmonology, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. Tel.: +7 (917) 985-32-85. E-mail: kodochigovaai@yandex.ru. ORCID: 0000-0002-4717-5671
Vyacheslav F. Kirichuk, MD, professor, head of the Department of normal physiology named after I.A. Chuevsky, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia, Honored scientist of the Russian Federation. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. ORCID: 0000-0002-5853-7316
Diana Z. Psanukova, 6th year student of medical Faculty, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. Tel.: +7 (937) 020-20-97. E-mail: dz.psanukova@mail.ru. ORCID: 0000-0001-9686-0993
Malakh O. Dzheyranova, 5th year student of medical Faculty, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. Tel.: +7 (986) 980-81-85. E-mail: malakh98@mail.ru. ORCID: 0000-0003-3372-2723
Tatiana M. Bogdanova, PhD, associate professor of the Department of therapy, gastroenterology and pulmonology, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. ORCID: 0000-0002-9203-451X
Mikhail S. Sinkeev, assistant of the Department of therapy, gastroenterology and pulmonology, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. ORCID: 0000-0003-1691-1397
Elena S. Olenko, MD, associate professor, professor of the Department of normal physiology named after I.A. Chuevsky, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. ORCID: 0000-0003-1573-0623

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