Anxiety in relation to inflammation and coagulation markers, among healthy adults: the ATTICA study

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.

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.

STAI score was positively correlated with C-reactive protein (rho = 0.18, p = 0.01), tumor necrosis factor-alpha (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.

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.