title: Momentary stress moderates procoagulant reactivity to a trauma-specific interview in patients with posttraumatic stress disorder caused by myocardial infarction.
abstract: Hypercoagulability of the blood might partially explain the increased cardiovascular disease risk in posttraumatic stress disorder (PTSD) and is also triggered by anticipatory stress. We hypothesized exaggerated procoagulant reactivity in patients with PTSD in response to a trauma-specific interview that would be moderated by momentary stress levels. We examined 23 patients with interviewer-diagnosed PTSD caused by myocardial infarction (MI) and 21 post-MI patients without PTSD. A second diagnostic (i.e., trauma-specific) interview to assess posttraumatic stress severity was performed after a median follow-up of 26 months (range 12-36). Before that interview patients rated levels of momentary stress (Likert scale 0-10) and had blood collected before and after the interview. The interaction between PTSD diagnostic status at study entry and level of momentary stress before the follow-up interview predicted reactivity of fibrinogen (P=0.036) and d-dimer (P=0.002) to the PTSD interview. Among patients with high momentary stress levels, PTSD patients had greater fibrinogen (P=0.023) and d-dimer (P=0.035) reactivity than non-PTSD patients. Among patients with low momentary stress levels, PTSD patients had less d-dimer reactivity than non-PTSD patients (P=0.024); fibrinogen reactivity did not significantly differ between groups. Momentary stress levels, but not severity of posttraumatic stress, correlated with d-dimer reactivity in PTSD patients (r=0.46, P=0.029). We conclude that momentary stress levels moderated the relationship between PTSD and procoagulant reactivity to a trauma-specific interview. Procoagulant reactivity in post-MI patients with PTSD confronted with their traumatically experienced MI was observed if patients perceived high levels of momentary stress before the interview.
authors.affiliation: Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland. roland.vonkaenel@insel.ch
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Chiara C
authors.initials: CC
authors.lastname: Abbas
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
authors.forename: André
authors.initials: A
authors.lastname: Haeberli
authors.forename: Monika
authors.initials: M
authors.lastname: Stutz
authors.forename: Stefan
authors.initials: S
authors.lastname: Begré
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000276:immunology*; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000523:psychology; D012307:Risk Factors; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D013315:Stress, Psychological / Q000097:blood* / Q000209:etiology; D011795:Surveys and Questionnaires
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen