***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The reporting of depressive symptoms following myocardial infa rct ion may be confounded by complaints originating from the myocardial infa rct ion . Therefore , it is difficult to estimate the effects of post-myocardial infa rct ion depression and its treatment on cardiovascular prognosis . The authors ' goal was to study the relationship between depressive symptom dimensions following myocardial infa rct ion and both somatic health status and prospect i ve cardiovascular prognosis . METHOD In two studies of myocardial infa rct ion patients ( N=494 and 1,972 ) , the Beck Depression Inventory was used to determine the dimensional structure of depressive symptoms following myocardial infa rct ion . Three symptom dimensions-somatic/affective , cognitive/affective , and appetitive-were compared with baseline left ventricular ejection fraction , Charlson comorbidity index , Killip class , and previous myocardial infa rct ion . The relationship between depressive symptom dimensions and prospect i ve cardiovascular mortality and cardiac-related readmissions was also examined ( mean follow-up duration = 2.5 years ) . RESULTS Somatic/affective symptoms were associated with poor health status ( left ventricular ejection fraction , Charlson comorbidity index , Killip class , and previous myocardial infa rct ion ) and predicted cardiovascular mortality and cardiac events . Cognitive/affective symptoms were only marginally associated with somatic health status and not with cardiovascular death and cardiac events . Appetitive symptoms were related to somatic health status but did not predict cardiovascular death or cardiac events . CONCLUSIONS Somatic/affective depressive symptoms following myocardial infa rct ion were confounded by somatic health status yet were prospect ively associated with cardiac prognosis even after somatic health status was controlled . Cognitive/affective depressive symptoms were only marginally related to health status and not to cardiac prognosis . These findings suggest that treatment of depression following myocardial infa rct ion might improve cardiovascular prognosis when it reduces somatic/affective symptoms BACKGROUND Individual symptoms of post-myocardial infa rct ion ( MI ) depression may be differentially associated with cardiac prognosis , in which somatic/affective symptoms appear to be associated with a worse cardiovascular prognosis than cognitive/affective symptoms . These findings hold important implication s for treatment but need to be replicated before conclusions regarding treatment can be drawn . We therefore examined the relationship between depressive symptom dimensions following MI and both disease severity and prospect i ve cardiac prognosis . METHOD Patients ( n=473 ) were assessed on demographic and clinical variables and completed the  Beck Depression Inventory ( BDI )  within the first week of hospital admission for acute MI . Depressive symptom dimensions were associated with baseline left ventricular ejection fraction ( LVEF ) and prospect i ve cardiac death and /or recurrent MI . The average follow-up period was 2.8 years . RESULTS Factor analysis revealed two symptom dimensions -- somatic/affective and cognitive/affective -- in the underlying structure of the BDI , identical to previous results . There were 49 events attributable to cardiac death ( n=23 ) or recurrent MI ( n=26 ) . Somatic/affective ( p=0.010 ) but not cognitive/affective ( p=0.153 ) symptoms were associated with LVEF and cardiac death/recurrent MI . When controlling for the effects of previous MI and LVEF , somatic/affective symptoms remained significantly predictive of cardiac death/recurrent MI ( hazard ratio 1.31 , 95 % confidence interval 1.02 - 1.69 , p=0.038 ) . Previous MI was also an independent predictor of cardiac death/recurrent MI . CONCLUSIONS We confirmed that somatic/affective , rather than cognitive/affective , symptoms of depression are associated with MI severity and cardiovascular prognosis . Interventions to improve cardiovascular prognosis by treating depression should be targeted at somatic aspects of depression BACKGROUND Trait anger , hostility , and serum level of homocysteine are associated with recurrent cardiac events after  percutaneous coronary interventions .  However , whether trait anger or hostility influences the association between serum level of homocysteine and recurrent cardiac events is unknown . OBJECTIVES To examine the relationships among trait anger , hostility , serum level of homocysteine , and recurrent cardiac events after percutaneous coronary interventions . METHODS This prospect i ve study included 135 consecutive patients ( 68 % male , mean age 61 [ SD , 10 ] years ) undergoing percutaneous coronary interventions during an index hospitalization .  Trait anger and hostility were measured with the Spielberger Trait Anger Scale and the Cynical Hostility Scale , respectively . Blood sample s were obtained to measure serum levels of total cholesterol , triglycerides , high- and low-density lipoprotein cholesterol , and homocysteine . Recurrent cardiac events ( emergency department visits and rehospitalization ) were noted for 6 months after discharge and confirmed by review of hospital records . Hierarchical Cox hazard regression was used for statistical analysis . RESULTS Trait anger ( hazard ratio = 1.11 , 95 % confidence interval = 1.03 - 1.20 ) and homocysteine level ( hazard ratio = 1.10 , 95 % confidence interval = 1.01 - 1.21 ) were independent predictors of recurrent cardiac events after other risk factors were controlled for . Patients with high trait anger  ( score > or = 24 ) and high serum level of homocysteine ( > or = 11.3 mumol/L ) had the shortest time to recurrent cardiac events ( P = .01 ) . CONCLUSION Trait anger had a combined effect on the link between serum level of homocysteine and recurrent cardiac events . Interventions to reduce trait anger may improve health outcomes by influencing both trait anger and homocysteine level Psychosocial variables predict the recurrence of clinical events in symptomatic patients , controlling for measures of disease severity . The Cardiac Arrhythmia Suppression Trial-1 , a pharmacologic test of the arrhythmia suppression and mortality hypothesis among postmyocardial infa rct ion patients , allowed a prospect i ve test of the relationship of distress , perceived support , social interaction , life stress , and other variables , to mortality , adjusting statistically for ejection fraction , arrhythmia rates , and other known risk factors for coronary heart disease . Results indicated that the treatment medications , encainide and flecainide , were powerful predictors of mortality . Although the psychosocial variables were significant as univariate predictors , these variables were not significant as predictors in a multivariate model that included drug treatment . When the data analysis was restricted to patients r and omized to placebo  , thereby eliminating the antiarrhythmic drug effect , the level of perceived social support was a significant multivariate predictor of mortality , adjusting for measures of disease severity . The adjusted hazards ratio for a 1-point decrease in the perceived support score is equal to 1.46 , based on the multivariate model 
    Output:
    
CONCLUSION Finding suggests that psychological distress in forms of depression , anxiety , anger , and hostility impact unfavorably on recurrent cardiac events in CAD patients