Effects of depressive symptoms and anxiety on hemostatic responses to acute mental stress and recovery in the elderly.
Depression and anxiety are prospectively associated with cardiac morbidity and mortality. Increased clotting diathesis may mediate this link. We hypothesized that there would be an association between mood and hemostatic changes that occur during and following recovery from acute mental stress. Forty-eight community-dwelling elderly subjects underwent a laboratory speech stressor task. Plasma von Willebrand factor (vWF), thrombin/antithrombin III (TAT) complexes, D-dimer, tissue-type plasminogen activator (t-PA), and type I plasminogen activator inhibitor (PAI-1) were measured at rest, after conclusion of the speech, and 14 min afterwards (recovery). Mood was assessed with the Hamilton Rating Scales for Depression (Ham-D) and Anxiety (Ham-A). Mental stress elicited a hypercoagulable state as evidenced by increases in TAT and D-dimer, and by a decrease in t-PA. Overall, hypercoagulability had increased after recovery. Ham-D scores and Ham-A scores correlated with increases in D-dimer over the testing interval (i.e. area under the curve). Ham-A (but not Ham-D) uniquely explained 8% and 17% of the variance in resting D-dimer and D-dimer area under the curve, respectively. The independent association of anxiety symptoms with resting and stress-induced fibrin formation (D-dimer) may be a mechanism linking mood with cardiovascular disease risk in the elderly.
von Känel
Roland
R
Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0680, USA.
Dimsdale
Joel E
JE
Adler
Karen A
KA
Patterson
Thomas L
TL
Mills
Paul J
PJ
Grant
Igor
I
D000208:Acute Disease; D000368:Aged; D001007:Anxiety / Q000097:blood* / Q000175:diagnosis / Q000523:psychology; D002318:Cardiovascular Diseases / Q000097:blood* / Q000503:physiopathology*; D003289:Convalescence; D003863:Depression / Q000097:blood* / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D008297:Male; D013315:Stress, Psychological / Q000097:blood* / Q000175:diagnosis; D011795:Surveys and Questionnaires; D013917:Thrombin / Q000378:metabolism; D010959:Tissue Plasminogen Activator / Q000097:blood; D014841:von Willebrand Factor / Q000378:metabolism
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014841:von Willebrand Factor; D013917:Thrombin; D010959:Tissue Plasminogen Activator