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Coagulation Activity Before and After Acute Psychosocial Stress Increases With Age

From the Department of Clinical Psychology and Psychotherapy (P.H.W., C.B., M.S., U.E.), University of Zurich, Switzerland; Department of Medicine (L.S.R.), Cardiology Branch, University of California, San Diego, San Diego, California, USA; Department of General Internal Medicine (R.v.K.), Bern University Hospital, Inselspital, and University of Bern, Switzerland.

Address correspondence and reprint requests to Petra H. Wirtz, Department of Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, Box 26, CH-8050 Zurich, Switzerland. E-mail: p.wirtz{at}psychologie.unizh.ch

Objective: To assess whether stress further increases hypercoagulation in older individuals. We investigated whether acute stress- induced changes in coagulation parameters differ with age. It is known that hypercoagulation occurs in response to acute stress and that a shift in hemostasis toward a hypercoagulability state occurs with age. However, it is not yet known whether acute stress further increases hypercoagulation in older individuals, and thus may increase their risk for cardiovascular disease (CVD).

Methods: A total of 63 medication-free nonsmoking men, aged between 20 and 65 years (mean ± standard error of the mean = 36.7 ± 1.7 years), underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience. We measured plasma clotting factor VII activity (FVII:C), fibrinogen, and D-dimer at rest, immediately, and 20 minutes after stress.

Results: Increased age predicted greater increases in fibrinogen (β = 0.26, p = 0.041; R² = 0.05), FVII:C (β = 0.40, p = .006; R² = 0.11), and D-dimer (β = 0.51, p < .001; R² = 0.18) from rest to 20 minutes after stress independent of body mass index and mean arterial blood pressure. General linear models revealed significant effects of age and stress on fibrinogen, FVII:C, and D-dimer (main effects: p < .04), and greater D-dimer stress reactivity with older age (interaction age-by-stress: F(1.5/90.4) = 4.36, p = .024; f = 0.33).

Conclusions: Our results suggest that acute stress might increase vulnerability in the elderly for hypercoagulability and subsequent hemostasis-associated diseases like CVD.

Key Words: age • coagulation • clotting factor VII:C • D-dimer • fibrinogen • psychological stress

Abbreviations: CVD = cardiovascular disease; ACS = acute coronary syndromes; BMI = body mass index; MAP = mean arterial pressure; BP = blood pressure; SEM = standard error of the mean; AUC = area under the curve; TSST = Trier Social Stress Test; FVII:C = clotting factor VII activity; FVIII:C = clotting factor VIII activity.

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