Hypercoagulability in working men and women with high levels of panic-like anxiety.

Background: There is growing evidence that cardiovascular diseases are relatively more prevalent in subjects who feel anxious. An increased clotting diathesis might subject anxious individuals to an elevated arterial thrombotic risk. We investigated whether panic-like anxiety would relate to a hypercoagulable state.

Methods: Study participants with a complete data set were 691 employees (mean age +/- SD 40 +/- 11 years, 83% men) recruited from two German companies. Subjects were asked to self-rate the onset of sudden feelings of panic in the previous week on a 4-point Likert scale: 0=not at all (n=416), 1=not very often (n=179), 2=quite often (n=55), and 3=very often indeed (n=41). Levels of fibrinogen, of the antifibrinolytic enzyme type 1 plasminogen activator inhibitor (PAI-1), and of the hypercoagulability marker fibrin D-dimer were measured in plasma.

Results: While the level of D-dimer was significantly different across the 4 scores of panic feelings (F3, 687=6.49, p <0.001), the levels of fibrinogen and PAI-1 were not. After having controlled for a range of confounders of hemostatic function, the 96 subjects reporting panic feelings either 'quite often' or 'very often indeed' had higher D-dimer levels (mean +/- SEM 165 +/- 12.0 vs. 145 +/- 4.3 ng/ml, F20, 670= 4.78, p=0.030) and lower fibrinogen levels (259 +/- 6.9 vs. 274 +/- 2.5 mg/dl, F20, 670=4.71, p=0.030) than the 595 subjects reporting panic feelings either 'not at all' or 'not very often'.

Conclusions: The findings suggest increased fibrin turnover with sudden feelings of panic. Prospective studies need to show whether such a procoagulant mechanism may contribute to the increased coronary risk with panic-like anxiety.