People who are depressed or who continue smoking after a heart attack often have chest pain a year later and are more likely to have another heart attack or die, U.S. researchers said on Monday.
Nearly one in five people have chest pain, whose medical term is angina, a year after a heart attack, they found.
Few studies have looked at factors influencing angina after a heart attack and the findings, reported in the Archives of Internal Medicine, may help doctors identify and better treat these patients.
Dr. Thomas Maddox of Denver Veterans Affairs Medical Center and colleagues studied questionnaires from 1,957 people a year after they had been hospitalized for heart attack between 2003 and 2004.
They found that 389 people, or 20 percent of those studied, reported chest pain a year after their hospitalization. Most had pain less than once a week.
One of the strongest associations with chest pain in this group was depression, especially symptoms that surfaced after the heart attack. Depressed people have a higher risk for a wide range of heart problems leading to hospitalization and death.
"Ideal care after (heart attack) for these patients may require routine screening for depressive symptoms to identify those at higher risk for angina," Maddox and colleagues wrote.
These patients could be treated with antidepressant medications, although whether these would reduce the risk of chest pain needs to be studied, they said.
Smoking was strongly associated with persistent chest pain after a heart attack, the researchers found.
Smoking is a well documented cause of heart disease and increases the risk of a second heart attack and death. The researchers said the findings suggest more work needs to be done to help smokers quit after a heart attack.
One shortcoming of the study, the researchers said, is that it did not include people who died in the preceding year, which could mean the study missed some people who had chest pain after a heart attack.
The study was funded in part by CV Therapeutics Inc, maker of a drug to treat chronic chest pain, and by a grant from the National Institutes of Health.
