Abstract
Objective: To determine the association of perceived stress with coagulation function and their predictive values for clinical outcomes.Methods: This prospective cohort study derived from a cross-sectional study for investigating the psychological status of inpatients with suspicious coronary heart disease (CHD). In this study, the 10-item Perceived Stress Scale (PSS-10) as an optional questionnaire was used to assess the severity of perceived stress. Coagulation function tests, such as activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen were measured within 1 h after admission. Furthermore, 241 patients with CHD out of 705 consecutive inpatients were included in the analyses and followed with a median of 26 months for the clinical outcomes.Results: The patients in high perceived stress status (PSS-10 score > 16) were with shorter APTT (36.71 vs. 38.45 s, p = 0.009). Shortened APTT ( ≤ 35.0 s) correlated with higher PSS-10 score (14.67 vs. 11.22, p = 0.003). The association of APTT with depression or anxiety was not found. Multiple linear models adjusting for PT estimated that every single point increase in PSS-10 was relevant to approximately 0.13 s decrease in APTT (p = 0.001) regardless of the type of CHD. APTT (every 5 s increase: hazard ratio (HR) 0.68 [0.47–0.99], p = 0.041) and perceived stress (every 5 points increase: HR 1.31 [1.09–1.58], p = 0.005) could predict the cardiovascular outcomes. However, both predictive values would decrease when they were simultaneously adjusted. After adjusting for the physical clinical features, the associated of perceived stress on cardiac (HR 1.25 [1.04–1.51], p = 0.020) and composite clinical outcomes (HR 1.24 [1.05–1.47], p = 0.011) persisted.Conclusions: For the patients with CHD, perceived stress strongly correlates with APTT. The activation of the intrinsic coagulation pathway is one of the mechanisms that high perceived stress causes cardiovascular events. This hints at an important role of the interaction of mental stress and coagulation function on cardiovascular prognosis. More attention needs to be paid to the patients with CHD with high perceived stress.
Highlights
Several large observational studies focusing general population have demonstrated that high perceived stress is associated with increased incidence of coronary heart disease (CHD) and risk for cardiovascular events [1,2,3], the underlying mechanisms of the negative influence of perceived stress on the cardiovascular system are rarely studied
For the patients with CHD, perceived stress strongly correlates with activated partial thromboplastin time (APTT)
The activation of the intrinsic coagulation pathway is one of the mechanisms that high perceived stress causes cardiovascular events. This hints at an important role of the Perceived Stress, APTT and CHD
Summary
Several large observational studies focusing general population have demonstrated that high perceived stress is associated with increased incidence of coronary heart disease (CHD) and risk for cardiovascular events [1,2,3], the underlying mechanisms of the negative influence of perceived stress on the cardiovascular system are rarely studied. The acute stressful laboratory tasks can cause a transient activation of coagulation and fibrinolysis in the general population and patients with major depression disorder [8,9,10]. One prior study observed a significant negative correlation between depression and APTT in the participants with low perceived social support [13]. It is reasonable to hypothesize that high perceived stress could through activating coagulation system to promote the occurrence of cardiovascular events. To the best of our knowledge, the studies concerning the relationships among the perceived stress, coagulation, and cardiac outcomes have previously not been published
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