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depression symptoms, ethnicity, fibrinolysis, hypertension



  1. Malan, Leone RN, PhD
  2. Mashele, Nyiko PhD
  3. Malan, Nicolaas T. DSc
  4. Harvey, Brian H. PhD
  5. Potgieter, Johan C. PhD
  6. Van Rooyen, Johannes M. DSc


Background: Hypercoagulation is associated with coronary artery disease (CAD). Whether depression symptoms dysregulate inflammatory and hemostatic markers in an African cohort is not known; therefore, we assessed the relationship between depressive symptoms and inflammatory and hemostatic markers as potential CAD risk markers in an African sex cohort.


Material and Methods: We included 181 black African urban-dwelling teachers (88 men, 93 women; aged 25-60 years) from the Sympathetic Activity and Ambulatory Blood Pressure in Africans Study. The Patient Health Questionnaire was used to assess depressive symptoms. Fasting plasma concentrations of C-reactive protein, fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1) and 24-hour blood pressure measures were obtained.


Results: Moderately severe depression symptom status was similar in the black sex groups. Both sex groups showed a mean hypertensive state and low-grade inflammation (C-reactive protein > 3 mg/L). Levels of PAI-1 were higher in depressed men, whereas D-dimer levels were lower in depressed women when considering concomitant confounders. In black men only, depressive symptoms were associated with levels of PAI-1 (adj. R2 = 0.12; [beta] = .22 [95% confidence interval, .0-.44]; P = .04) and D-dimer (adj. R2 = 0.12; [beta] = .28 [95% confidence interval, .08-.48]; P = .01), independent of confounders.


Conclusion: In black men, depression symptoms accompanied by a mean hypertensive status may up-regulate inflammatory and thrombotic processes. Depression symptoms in black men facilitated hypercoagulation or fibrinolytic dysregulation and potentially increased their CAD risk. Early screening of fibrinolytic markers and for the presence of depressive symptoms is recommended.