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Anticipatory Cognitive Stress Appraisal and the Acute Procoagulant Stress Response in Men

From the Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland (P.H.W., U.E., L.E., K.R., S.G., J.G.); the Department of Medical Psychology, University Hospital of Essen Medical School, Essen, Germany (S.E.); the Department of General Internal Medicine, University Hospital Berne, Berne, Switzerland (R.v.K.); and the Psychocardiology Unit, Cardiovascular Prevention and Rehabilitation, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland (R.v.K.).

Address correspondence and reprint requests to Roland von Känel, MD, Professor of Medicine and Head of Psychosomatic Division, Department of General Internal Medicine University Hospital/INSELSPITAL, CH-3010 Bern, Switzerland. E-mail: roland.vonkaenel{at}insel.ch

Objective: Acute mental stress elicits blood hypercoagulability. Following a transactional stress model, we investigated whether individuals who anticipate stress as more threatening, challenging, and as exceeding their coping skills show greater stress reactivity of the coagulation activation marker D-dimer, indicating fibrin generation in plasma.

Methods: Forty-seven men (mean age 44 ± 14 years; mean blood pressure [MBP] 101 ± 12 mm Hg; mean body mass index [BMI] 26 ± 3 kg/m²) completed the Primary Appraisal Secondary Appraisal (PASA) scale before undergoing the Trier Social Stress Test (combination of mock job interview and mental arithmetic task). Heart rate, blood pressure, plasma catecholamines, and D-dimer levels were measured before and after stress, and during recovery up to 60 minutes poststress.

Results: Hemodynamic measures, catecholamines, and D-dimer changed across all time points (p values <.001). The PASA "Stress Index" (integrated measure of transactional stress perception) correlated with total D-dimer area under the curve (AUC) between rest and 60 minutes poststress (r = 0.30, p = .050) and with D-dimer change from rest to immediately poststress (r = 0.29, p = .046). Primary appraisal (combined "threat" and "challenge") correlated with total D-dimer AUC (r = 0.37, p = .017), D-dimer stress change (r = 0.41, p = .004), and D-dimer recovery (r = 0.32, p = .042). "Challenge" correlated more strongly with D-dimer stress change than "threat" (p = .020). Primary appraisal (R² = 0.098, ß = 0.37, p = .019), and particularly its subscale "challenge" (R² = 0.138, ß = 0.40, p = .005), predicted D-dimer stress change independently of age, BP, BMI, and catecholamine change.

Conclusions: Anticipatory cognitive appraisal determined the extent of coagulation activation to and recovery from stress in men. Particularly individuals who anticipated the stressor as more challenging and also more threatening had a greater fibrin stress response.

Key Words: blood coagulation • cognitive appraisal • psychological stress

Abbreviations: AUC = area under the curve; BMI = body mass index; CAD = coronary artery disease; EPI = epinephrine; HR = heart rate; MBP = mean blood pressure; NEPI = norepinephrine; PASA = Primary Appraisal Secondary Appraisal; TSST = Trier Social Stress Test.

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