title: Depression Symptoms Facilitated Fibrinolytic Dysregulation and Future Coronary Artery Disease Risk in a Black Male Cohort: The Sympathetic Activity and Ambulatory Blood Pressure in Africans Study.
abstract: BACKGROUND
  Hypercoagulation is associated with coronary artery disease (CAD). Whether depression symptoms dysregulate inflammatory and hemostatic markers in an African cohort is not known; therefore, we assessed the relationship between depressive symptoms and inflammatory and hemostatic markers as potential CAD risk markers in an African sex cohort.
  
  
  METHODS
  We included 181 black African urban-dwelling teachers (88 men, 93 women; aged 25-60 years) from the Sympathetic Activity and Ambulatory Blood Pressure in Africans Study. The Patient Health Questionnaire was used to assess depressive symptoms. Fasting plasma concentrations of C-reactive protein, fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1) and 24-hour blood pressure measures were obtained.
  
  
  RESULTS
  Moderately severe depression symptom status was similar in the black sex groups. Both sex groups showed a mean hypertensive state and low-grade inflammation (C-reactive protein > 3 mg/L). Levels of PAI-1 were higher in depressed men, whereas D-dimer levels were lower in depressed women when considering concomitant confounders. In black men only, depressive symptoms were associated with levels of PAI-1 (adj. R = 0.12; β = .22 [95% confidence interval, .0-.44]; P = .04) and D-dimer (adj. R = 0.12; β = .28 [95% confidence interval, .08-.48]; P = .01), independent of confounders.
  
  
  CONCLUSIONS
  In black men, depression symptoms accompanied by a mean hypertensive status may up-regulate inflammatory and thrombotic processes. Depression symptoms in black men facilitated hypercoagulation or fibrinolytic dysregulation and potentially increased their CAD risk. Early screening of fibrinolytic markers and for the presence of depressive symptoms is recommended.
authors.affiliation: Leoné Malan, RN, PhD Professor, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa. Nyiko Mashele, PhD PhD Student, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa. Nicolaas T. Malan, DSc Research Professor, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa. Brian H. Harvey, PhD Professor, Center of Excellence for Pharmaceutical Sciences, Division of Pharmacology, School for Pharmacy, North-West University, Potchefstroom Campus, South Africa. Johan C. Potgieter, PhD Professor, School for Psychosocial Behavioral Sciences, North-West University, Potchefstroom Campus, South Africa. Johannes M. Van Rooyen, DSc Professor, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa.
authors.forename: Leoné
authors.initials: L
authors.lastname: Malan
authors.forename: Nyiko
authors.initials: N
authors.lastname: Mashele
authors.forename: Nicolaas T
authors.initials: NT
authors.lastname: Malan
authors.forename: Brian H
authors.initials: BH
authors.lastname: Harvey
authors.forename: Johan C
authors.initials: JC
authors.lastname: Potgieter
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Van Rooyen
mesh_terms: D000328:Adult; D001741:Black or African American; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D003863:Depression / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis*; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D002097:C-Reactive Protein