Thromb Haemost 2013; 110(05): 977-986
DOI: 10.1160/TH13-05-0383
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Procoagulant reactivity to laboratory acute mental stress in Africans and Caucasians, and its relation to depressive symptoms: The SABPA Study

Roland von Känel
1  Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Switzerland
2  Department of Clinical Research, University of Bern, Switzerland
,
Mark Hamer
3  Department of Epidemiology and Public Health, University College London, UK
4  Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa
,
Nico T. Malan
4  Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa
,
Kobus Scheepers
4  Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa
,
Muriel Meiring
5  Department of Haematology and Cell Biology, University of the Free State, Bloemfontein, South Africa
,
Leonè Malan
4  Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa
› Author Affiliations
Further Information

Publication History

Received: 11 May 2013

Accepted after major revision: 20 July 2013

Publication Date:
01 December 2017 (online)

Summary

The risk of cardiovascular disease is dramatically increasing in Africans (black). The prothrombotic stress response contributes to atherothrombotic disease and is modulated by depressive symptoms. We examined coagulation reactivity to acute mental stress and its relation to psychological well-being in Africans relative to Caucasians (white). A total of 102 African and 165 Caucasian school teachers underwent the Stroop Color-Word Conflict test. Circulating levels of von Willebrand factor (VWF) antigen, fibrinogen, and D-dimer were measured before and after the Stroop. Cardiovascular reactivity measures were also obtained. All participants completed the Patient Health Questionnaire-9 and the General Health Questionnaire-28 for the assessment of depressive symptoms and total psychological distress, respectively. After controlling for covariates, resting levels of VWF, fibrinogen, and D-dimer were higher in Africans than in Caucasians (all p-values ≤0.006). Depressive symptoms and psychological distress were not significantly associated with resting coagulation measures. Stress reactivity in VWF (p<0.001) and fibrinogen (p=0.016), but not in D-dimer (p=0.27), were decreased in Africans relative to Caucasians with Africans showing greater reactivity of total peripheral resistance (p=0.017). Depressive symptoms, but not general psychological distress, were associated with greater VWF increase (p=0.029) and greater fibrinogen decrease (p=0.030) in Africans relative to Caucasians. In conclusion, Africans showed greater hypercoagulability at rest but diminished procoagulant reactivity to acute mental stress when compared with Caucasians. Ethnic differences in the vascular adrenergic stress response might partially explain this finding. Depressive symptoms were associated with exaggerated VWF reactivity in Africans relative to Caucasians. The clinical implications of these findings for Africans need further study.