Circulating fibrinogen but not D-dimer level is associated with vital exhaustion in school teachers

Meta-analyses have established elevated fibrinogen and D-dimer levels in the circulation as biological risk factors for the development and progression of coronary artery disease (CAD). Here, we investigated whether vital exhaustion (VE), a known psychosocial risk factor for CAD, is associated with fibrinogen and D-dimer levels in a sample of apparently healthy school teachers. The teaching profession has been proposed as a potentially high stressful occupation due to enhanced psychosocial stress at the workplace. Plasma fibrinogen and D-dimer levels were measured in 150 middle-aged male and female teachers derived from the first year of the Trier-Teacher-Stress-Study. Log-transformed levels were analyzed using linear regression. Results yielded a significant association between VE and fibrinogen (p = 0.02) but not D-dimer controlling for relevant covariates. Further investigation of possible interaction effects resulted in a significant association between fibrinogen and the interaction term "VE x gender" (p = 0.05). In a secondary analysis, we reran linear regression models for males and females separately. Gender-specific results revealed that the association between fibrinogen and VE remained significant in males but not females. In sum, the present data support the notion that fibrinogen levels are positively related to VE. Elevated fibrinogen might be one biological pathway by which chronic work stress may impact on teachers' cardiovascular health in the long run.

Heart rate recovery after exercise in chronic heart failure: Role of vital exhaustion and type D personality

OBJECTIVE: Vital exhaustion and type D personality previously predicted mortality and cardiac events in patients with chronic heart failure (CHF). Reduced heart rate recovery (HRR) also predicts morbidity and mortality in CHF. We hypothesized that elevated levels of vital exhaustion and type D personality are both associated with decreased HRR. METHODS: Fifty-one patients with CHF (mean age 58+/-12 years, 82% men) and left ventricular ejection fraction (LVEF) derwent standard exercise testing before receiving outpatient cardiac rehabilitation. They completed the 9-item short form of the Maastricht Vital Exhaustion Questionnaire and the 14-item type D questionnaire asking about negative affectivity and social inhibition. HRR was calculated as the difference between heart rate at the end of exercise and 1min after abrupt cessation of exercise (HRR-1). Regression analyses were adjusted for gender, age, LVEF, and maximum exercise capacity. RESULTS: Vital exhaustion explained 8.4% of the variance in continuous HRR-1 (p=0.045). For each point increase on the vital exhaustion score (range 0-18) there was a mean+/-SEM decrease of 0.54+/-0.26bpm in HRR-1. Type D personality showed a trend toward statistical significance for being associated with lower levels of HRR-1 explaining 6.5% of the variance (p<0.08). The likelihood of having HRR-1D personality than in those without (odds ratio=7.62, 95% CI 1.50-38.80). CONCLUSIONS: Elevated levels of vital exhaustion and type D personality were both independently associated with reduced HRR-1. The findings provide a hitherto not explored psychobiological explanation for poor cardiac outcome in patients with CHF.

Verhalten der Gewichtsdifferenz von selektiv wachstumsretardierten, monochorialen Zwillingen

Problemstellung: Monochoriale Zwillinge (MZ) machen nur ca. 1/3 aller Mehrlinge aus. Im Vergleich zu dichorialen weisen sie jedoch eine höhere Morbidität und Mortalität auf bedingt durch das Transfusionssyndrom, mehr Fehlbildungen und Frühgeburten. In letzter Zeit kristallisiert sich eine weitere Entität heraus, die selektive intrauterine Wachstumsretardierung (sIUWR). Ziel der Studie war es, das Verhalten dieses diskordanten Wachstums im Verlaufe der Schwangerschaft zu untersuchen. Patienten und Methode: Die Diagnose einer monochorialen Situation basiert auf der Darstellung nur einer Plazenta, dem T-Sign sowie gleichgeschlechtiger Feten. Es wurden nur biamniote MZ eingeschlossen. Von einer sIUWR spricht man, wenn folgende Kriterien erfüllt sind: 1) ein Fetus wachstumsretardiert (Abdomenumfang <5. Perzentile) und 2) Gewichtsdifferenz beider Feten >20%. Letztere berechnet sich aus der Differenz der geschätzten fetalen Gewichte dividiert durch das Gewicht des Größeren in% (Delta%). Es wurden die Delta%-Werte bei Diagnosestellung und die letzten Werte vor Geburt verglichen. Ergebnisse: Retrospektiv wurden 23 Fälle mit sIUWR eingeschlossen, davon wurden 13 Fälle longitudinal beurteilt. Das mediane Gestationsalter bei Geburt lag bei 31,4 (16,7–38,6) Wochen. Die Frühgeburtsrate betrug 85,7%, die perinatale Mortalität 11,9%. Der initiale Delta%-Wert lag bei 28±10% und stieg signifikant auf 36,4±9,9%. In allen Fällen nahm der Delta%-Wert zu. Von den Co-Zwillingen waren postnatal 20% auch small for gestational age. Schlussfolgerungen: Bei MZ mit sIUWR ist nach unseren Erfahrungen damit zu rechnen, dass die Gewichtsdifferenz mit zunehmendem Gestationsalter steigt. Diese Zunahme erklärt sich durch eine progressive Verlangsamung der Wachstumsgeschwindigkeit des kleineren Feten. Leider lässt sich anhand der kleinen Fallzahl nicht eruieren, ob dieser D%-Wert und der Grad des Anstieges eine prognostische Bedeutung aufweist.

Association of vital exhaustion and depressive symptoms with changes in fibrin D-dimer to acute psychosocial stress

OBJECTIVE: Vital exhaustion and depression are psychosocial risk factors of coronary artery disease. A hypercoagulable state in response to acute psychosocial stress contributes to atherothrombotic events. We aimed to investigate the hypothesis that vital exhaustion and depression correlate with stress-induced changes in the hypercoagulability marker D-dimer. METHODS: Thirty-eight healthy and nonsmoking school teachers (mean age 50+/-8 years, 55% women) completed the nine-item Maastricht Vital Exhaustion Questionnaire and the seven-item depression subscale of the Hospital Anxiety and Depression Scale. Within 1 week, subjects twice underwent the Trier Social Stress Test (i.e., preparation phase, mock job interview, and mental arithmetic that totaled 13 min). Plasma D-dimer levels were determined at five time points during the protocol. RESULTS: Vital exhaustion (P=.022; eta(2)=.080) and depressive symptoms (P=.011; eta(2)=.090) were associated with stress-induced changes in D-dimer levels over time controlling for sex and age. Elevated levels of vital exhaustion (r=-.46, P=.005) and of depression (r=-.51, P=.002) correlated with reduced D-dimer increase from pre-stress to immediately post-stress. Also, elevated vital exhaustion (r=.34, P=.044) and depression (r=.41, P=.013) were associated with increase (i.e., attenuated recovery) of D-dimer levels between 20 and 45 min post-stress. Controlling for stress hormone and blood pressure reactivity did not substantially alter these results. CONCLUSION: The findings suggest an attenuated immediate D-dimer stress response and delayed recovery of D-dimer levels post-stress with elevated vital exhaustion and depressive symptoms. In particular, the prolonged hypercoagulability after stress cessation might contribute to the atherothrombotic risk previously observed with vital exhaustion and depression, even at subclinical levels.