Advertisement

Anxiety in relation to inflammation and coagulation markers, among healthy adults: The ATTICA Study

      Abstract

      Background

      Anxiety is a complex feeling of uneasiness, fear and worry, which has been associated with pulmonary, cardiovascular and other adverse health conditions. The aim of this work is to examine the association of the anxious state with inflammation and coagulation factors, in persons free of cardiovascular disease.

      Methods

      From May 2001 to December 2002 we randomly enrolled 453 men (19 to 89 years old) and 400 women (18 to 84 years old) stratified by age and gender, from Attica area, Greece. Among others, various inflammation and coagulation markers (C-reactive protein (CRP), amyloid-A, interleukin-6, tumor necrosis factor-alpha, white blood cell (WBC), homocysteine and fibrinogen) were evaluated in relation to the anxious state (assessed by the Spielberger State Anxiety Inventory, STAI) of participants, after several adjustments made for potential confounders.

      Results

      STAI score was positively correlated with C-reactive protein (rho = 0.18, p = 0.01), tumor necrosis factor-α (rho = 0.11, p = 0.03), interleukin-6 (rho = 0.09, p = 0.03), homocysteine (rho = 0.10, p = 0.03) and fibrinogen levels (rho = 0.08, p = 0.04), in men, and positively correlated with C-reactive protein (rho = 0.22, p = 0.01), white blood cell counts (rho = 0.15, p = 0.02), interleukin-6 (rho = 0.12, p = 0.02), homocysteine (rho = 0.07, p = 0.04) and fibrinogen levels (rho = 0.07, p = 0.04), in women. These associations remained significant even after various adjustments were made.

      Conclusion

      This study revealed that anxiety was associated with inflammation and coagulation markers in cardiovascular disease-free people. This may raise a hypothesis of a pathway leading to increased cardiovascular events in anxious individuals.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Reyes-Ortiz C.A.
        Psychosocial interventions in coronary artery disease.
        Arch Intern Med. 1997; 157: 130-137
        • Hemingway H.
        • Marmot M.
        Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies.
        BMJ. 1999; 318: 1460-1467
        • Rozanski A.
        • Blumenthal J.
        • Kaplan J.
        Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy.
        Circulation. 1999; 99: 2192-2217
        • Spielberger C.D.
        • Gorsuch R.L.
        • Lushene R.E.
        Manual for the state-trait anxiety inventory (STAI).
        Calif Consulting Psychologists Press Inc., Palo Alto1970
        • Kawachi I.
        • Colditz G.A.
        • Asherio A.
        • et al.
        Prospective study of phobic anxiety and risk of coronary heart disease in men.
        Circulation. 1994; 89: 1992-1997
        • Melamed S.
        • Shirom A.
        • Toker S.
        • Berliner S.
        • Shapira I.
        Association of fear of terror with low-grade inflammation among apparently healthy employed adults.
        Psychosom Med. 2004; 66: 484-491
        • Bryne D.G.
        • Rosenman R.H.
        Bryne DG. Rosenman R.H. Anxiety and the heart. Hemisphere Publishing Corporation, New York1990 (p. xv–xvii)
        • Piek J.J.
        • van der Wal A.C.
        • Meuwissen M.
        Plaque inflammation in restenotic coronary lesions of patients with stable or unstable angina.
        J Am Coll Cardiol. 2000; 35: 963-967
        • Libby P.
        Inflammation in atherosclerosis.
        Nature. 2002; 420: 868-874
        • Das U.N.
        Obesity, metabolic syndrome X and inflammation.
        Nutrition. 2002; 18: 430-432
        • Leonard B.
        Stress, depression and the activation of the immune system.
        World J Biol Psychiatry. 2000; 1: 17-25
        • Appels A.
        • Bar F.W.
        • Bar J.
        • Bruggeman C.
        • De Baets M.
        Inflammation, depressive symptomatology, and coronary artery disease.
        Psychosom Med. 2000; 62: 601-605
        • Miller G.
        • Stetler C.
        • Carney R.
        • Freedland K.
        • Banks W.
        Clinical depression and inflammatory risk markers for coronary heart disease.
        Am J Cardiol. 2002; 90: 1279-1283
        • Anisman H.
        • Merali Z.
        Cytokines, stress and depressive illness: brain–immune interactions.
        Ann Intern Med. 2003; 35: 2-11
        • Panagiotakos D.
        • Pitsavos C.
        • Chrysohoou C.
        • et al.
        Inflammation, coagulation and depressive symptomatology, in cardiovascular disease-free people; The ATTICA Study.
        Eur Heart J. 2004; 25: 492-499
        • Pitsavos C.
        • Panagiotakos D.B.
        • Chrysohoou C.
        • Stefanadis C.
        Epidemiology of cardiovascular risk factors in Greece; aims, design and baseline characteristics of the ATTICA study.
        BMC Public Health. 2003; 9: 1
        • Katsouyanni K.
        • Rimm E.B.
        • Gnardellis C.
        • et al.
        Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers.
        Int J Epidemiol. 1997; 26: S118-S127
      1. Supreme Scientific Health Council, Ministry of Health and Welfare of Greece. Dietary guidelines for adults in Greece. Arch Hellenic Med. 1999;16:516–24.

        • Kubzansky L.D.
        • Kawachi I.
        • Spiro III, A.
        • et al.
        Is worrying bad for your heart? A prospective study of worry and coronary heart disease in the Normative Aging Study.
        Circulation. 1997; 95: 818-824
        • Zung W.
        A self-rating depression scale.
        Arch Gen Psychiatry. 1965; 12: 63-70
        • Lebovitis B.
        • Lichter E.
        • Moses V.
        Personality correlates of coronary heart disease.
        Soc Sci Med. 1975; 9: 207-219
      2. Jenkins C. Recent evidence supporting psychologic and social risk factors for coronary disease. N Eng J Med 1976; 294:987–994, 1033–1038.

        • Zyzanski S.
        • Jenkins C.
        • Ryan T.
        Psychological correlates of coronary angiographic findings.
        Arch Int Med. 1976; 136: 1234-1237
        • Ballenger J.C.
        • Davidson J.R.
        • Lecrubier Y.
        • et al.
        International Consensus Group on Depression and Anxiety. Consensus statement on depression, anxiety, and cardiovascular disease.
        J Clin Psychiatry. 2001; 62: 24-27
        • Hayward C.
        Psychiatric illness and cardiovascular disease risk.
        Epidemiol Rev. 1995; 17: 129-138
        • Kubzansky L.D.
        • Kawachi I.
        • Weiss S.
        • Sparrow D.
        Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence.
        Ann Behav Med. 1998; 20: 47-58
        • Freedman D.S.
        • Byers T.
        • Barrett D.H.
        • et al.
        Plasma lipid levels and psychological characteristics in men.
        Am J Epidemiol. 1995; 141: 507-517
        • Von Kanel R.
        • Mills P.J.
        • Fainman C.
        • Dimsdale J.E.
        Effects of psychological stress and psychiatric disorders on blood coagulation and fibrinolysis: a biobehavioral pathway to coronary artery disease?.
        Psychosom Med. 2001; 63: 531-544
        • Bjelland I.
        • Tell G.S.
        • Vollset S.E.
        • Refsum H.
        • Ueland P.M.
        Folate, Vitamin B12, homocysteine, and the MTHFR 677C->T polymorphism in anxiety and depression: the Hordaland Homocysteine Study.
        Arch Gen Psychiatry. 2003; 60: 618-626
        • Maes M.
        • Song C.
        • Lin A.
        • et al.
        The effects of psychological stress on humans: increased production of pro-inflammatory cytokines and a Th1-like response in stress-induced anxiety.
        Cytokine. 1998; 10: 313-318
        • Simonds V.M.
        • Whiffen V.E.
        Are gender differences in depression explained by gender differences in co-morbid anxiety?.
        J Affect Disord. 2003; 77: 197-202
        • Miller G.
        • Stetler C.
        • Carney R.
        • Freedland K.
        • Banks W.
        Clinical depression and inflammatory risk markers for coronary heart disease.
        Am J Cardiol. 2002; 90: 1279-1283
        • Danner M.
        • Kasl S.
        • Abramson J.
        • Vaccarino V.
        Association between depression and elevated C-reactive protein.
        Psychos Med. 2003; 65: 347-356
        • Panagiotakos D.B.
        • Pitsavos C.
        • Chrysohoou C.
        • et al.
        ATTICA study. Inflammation, coagulation, and depressive symptomatology in cardiovascular disease-free people; The ATTICA Study.
        Eur Heart J. 2004; 25: 492-499