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Thromb Haemost 2012; 107(03): 485-493
DOI: 10.1160/TH11-09-0667
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Emotional states and future risk of venous thromboembolism

The Tromsø Study
Kristin F. Enga
1   Hematological research group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
,
Sigrid K. Brækkan
1   Hematological research group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
2   Division of Internal Medicine, University Hospital of North Norway, Tr omsø, Norway
,
Ida J. Hansen-Krone
1   Hematological research group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
,
John-Bjarne Hansen
1   Hematological research group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
2   Division of Internal Medicine, University Hospital of North Norway, Tr omsø, Norway
› Author Affiliations
Further Information

Publication History

Received: 24 September 2011

Accepted after major revision: 09 February 2011

Publication Date:
22 November 2017 (online)

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Summary

Emotional states of depression and loneliness are reported to be associated with higher risk and optimism with lower risk of arterial cardiovascular disease (CVD) and death. The relation between emotional states and risk of venous thromboembolism (VTE) has not been explored previously. We aimed to investigate the associations between self-reported emotional states and risk of incident VTE in a population-based, prospective study. The frequency of feeling depressed, lonely and happy/optimistic were registered by self-administered questionnaires, along with major co-morbidities and lifestyle habits, in 25,964 subjects aged 25–96 years, enrolled in the Tromsø Study in 1994–1995. Incident VTE-events were registered from the date of inclusion until September 1, 2007. There were 440 incident VTE-events during a median of 12.4 years of follow-up. Subjects who often felt depressed had 1.6-fold (95% CI:1.02–2.50) higher risk of VTE compared to those not depressed in analyses adjusted for other risk factors (age, sex , body mass index, oes-trogens), lifestyle (smoking, alcohol consumption, educational level) and co-morbidities (diabetes, CVD, and cancer). Often feeling lonely was not associated with VTE. However, the incidence rate of VTE in subjects who concurrently felt often lonely and depressed was higher than for depression alone (age-and sex-adjusted incidence rate: 3.27 vs. 2.21). Oppositely, subjects who often felt happy/optimistic had 40% reduced risk of VTE (HR 0.60, 95% CI: 0.41–0.87). Our findings suggest that self-reported emotional states are associated with risk of VTE. Depressive feelings were associated with increased risk, while happiness/ optimism was associated with reduced risk of VTE.

Keywords

Depression - emotional states - happiness - psychosocial factor - venous thromboembolism
 

  • References

  • 1 Beckman MG, Hooper WC, Critchley SE. et al. Venous thromboembolism: a public health concern. Am J Prev Med 2010; 38: S495-501.
    CrossrefPubMedGoogle Scholar
  • 2 Heit JA. Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost 2005; 03: 1611-1617.
    CrossrefPubMedGoogle Scholar
  • 3 Rosendaal FR. Venous thrombosis: the role of genes, environment, and behavior. Hematology Am Soc Hematol Educ Program 2005; 1-12.
    PubMedGoogle Scholar
  • 4 White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107: I4-8.
    PubMedGoogle Scholar
  • 5 Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 2002; 72: 227-236.
    CrossrefPubMedGoogle Scholar
  • 6 Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med 2010; 40: 218-227.
    CrossrefPubMedGoogle Scholar
  • 7 Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med 2008; 70: 741-756.
    CrossrefPubMedGoogle Scholar
  • 8 Rugulies R. Depression as a predictor for coronary heart disease. a review and meta-analysis. Am J Prev Med 2002; 23: 51-61.
    CrossrefPubMedGoogle Scholar
  • 9 Eaker ED, Pinsky J, Castelli W P. Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Fram-ingham Study. Am J Epidemiol 1992; 135: 854-864.
    CrossrefPubMedGoogle Scholar
  • 10 Thurston RC, Kubzansky LD. Women, loneliness, and incident coronary heart disease. Psychosom Med 2009; 71: 836-842.
    CrossrefPubMedGoogle Scholar
  • 11 Kubzansky LD, Sparrow D, Vokonas P. et al. Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the normative aging study. Psychosom Med 2001; 63: 910-916.
    CrossrefPubMedGoogle Scholar
  • 12 Giltay EJ, Geleijnse JM, Zitman FG. et al. Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly dutch men and women. Arch Gen Psychiatry 2004; 61: 1126-1135.
    CrossrefPubMedGoogle Scholar
  • 13 Davidson KW, Mostofsky E, Whang W. Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia Health Survey. Eur Heart J 2010; 31: 1065-1070.
    CrossrefPubMedGoogle Scholar
  • 14 Rosengren A, Freden M, Hansson PO. et al. Psychosocial factors and venous thromboembolism: a long-term follow-up study of Swedish men. J Thromb Hae-most 2008; 06: 558-564.
    CrossrefPubMedGoogle Scholar
  • 15 Braekkan SK, Mathiesen EB, Njolstad I. et al. Family history of myocardial infarction is an independent risk factor for venous thromboembolism: the Tromso study. J Thromb Haemost 2008; 06: 1851-1857.
    CrossrefPubMedGoogle Scholar
  • 16 Hansen-Krone IJ, Braekkan SK, Enga K F. et al. Alcohol consumption, types of alcoholic beverages and risk of venous thromboembolism – The Tromso Study. Thromb Haemost 2011; 106: 272-278.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Thrall G, Lane D, Carroll D. et al. A systematic review of the effects of acute psychological stress and physical activity on haemorheology, coagulation, fibrinoly-sis and platelet reactivity: Implications for the pathogenesis of acute coronary syndromes. Thromb Res 2007; 120: 819-847.
    CrossrefPubMedGoogle Scholar
  • 18 Lutsey PL, Folsom AR, Heckbert SR. et al. Peak thrombin generation and subsequent venous thromboembolism: the Longitudinal Investigation of Throm-boembolism Etiology (LITE) study. J Thromb Haemost 2009; 07: 1639-1648.
    CrossrefPubMedGoogle Scholar
  • 19 Meltzer ME, Lisman T, de Groot PG. et al. Venous thrombosis risk associated with plasma hypofibrinolysis is explained by elevated plasma levels of TAFI and PAI-1. Blood 2010; 116: 113-121.
    CrossrefPubMedGoogle Scholar
  • 20 Braekkan SK, Mathiesen EB, Njolstad I. et al. Mean platelet volume is a risk factor for venous thromboembolism: the Tromso Study, Tromso, Norway. J Thromb Haemost 2010; 08: 157-162.
    CrossrefPubMedGoogle Scholar
  • 21 Shiovitz-Ezra S, Ayalon L. Situational versus chronic loneliness as risk factors for all-cause mortality. International Psychogeriatrics. Int Psychogeriatr 2010; 22: 455-462.
    CrossrefPubMedGoogle Scholar
  • 22 Win S, Parakh K, Eze-Nliam CM. et al. Depressive symptoms, physical inactivity and risk of cardiovascular mortality in older adults: the Cardiovascular Health Study. Heart 2011; 97: 500-50.
    CrossrefPubMedGoogle Scholar
  • 23 Olsen RB, Olsen J, Gunner-Svensson F. et al. Social networks and longevity. A 14 year follow-up study among elderly in Denmark. Soc Sci Med 1991; 33: 1189-11.
    CrossrefPubMedGoogle Scholar
  • 24 Everson SA, Roberts RE, Goldberg DE. et al. Depressive symptoms and increased risk of stroke mortality over a 29-year period. Arch Intern Med 1998; 158: 1133-1138.
    CrossrefPubMedGoogle Scholar
  • 25 Stek ML, Vinkers DJ, Gussekloo J. et al. Is depression in old age fatal only when people feel lonely?. Am J Psychiatry 2005; 162: 178-180.
    CrossrefPubMedGoogle Scholar
  • 26 Davidson K, Jonas BS, Dixon KE. et al. Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Coronary Artery Risk Development in Young Adults. Arch Intern Med 2000; 160: 1495-1500.
    CrossrefPubMedGoogle Scholar
  • 27 Golden SH, Williams JE, Ford DE. et al. Depressive symptoms and the risk of type 2 diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care 2004; 27: 429-435.
    CrossrefPubMedGoogle Scholar
  • 28 Whisman MA. Loneliness and the metabolic syndrome in a population-based sample of middle-aged and older adults. Health Psychol 2010; 29: 550-554.
    CrossrefPubMedGoogle Scholar
  • 29 Magnusson A. An overview of epidemiological studies on seasonal affective disorder. Acta Psych Scand 2000; 101: 176-184.
    CrossrefPubMedGoogle Scholar
  • 30 Dentali F, Ageno W, Rancan E. et al. Seasonal and monthly variability in the incidence of venous thromboembolism. A systematic review and a meta-analysis of the literature. Thromb Haemost 2011; 106: 439-447.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry 1998; 55: 580-592.
    CrossrefPubMedGoogle Scholar
  • 32 Dockray S, Steptoe A. Positive affect and psychobiological processes. Neurosci Biobehav Rev 2010; 35: 69-75.
    CrossrefPubMedGoogle Scholar
  • 33 Rozanski A, Blumenthal JA, Davidson KW. et al. The epidemiology, pathophysi-ology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005; 45: 637-651.
    CrossrefPubMedGoogle Scholar
  • 34 Schins A, Honig A, Crijns H. et al. Increased coronary events in depressed cardiovascular patients: 5-HT2A receptor as missing link?. Psychosom Med 2003; 65: 729-737.
    CrossrefPubMedGoogle Scholar
  • 35 Steptoe A, Wardle J. Positive affect and biological function in everyday life. Neur-obiol Aging 2005; 26 (Suppl. 01) 108-112.
    CrossrefPubMedGoogle Scholar
  • 36 Maes M, Delange J, Ranjan R. et al. Acute phase proteins in schizophrenia, mania and major depression: modulation by psychotropic drugs. Psychiatry Res 1997; 66: 1-11.
    CrossrefPubMedGoogle Scholar
  • 37 Roy B, Diez-Roux AV, Seeman T. et al. Association of optimism and pessimism with inflammation and hemostasis in the Multi-Ethnic Study of Atherosclerosis (MESA). Psychosom Med 2010; 72: 134-140.
    CrossrefPubMedGoogle Scholar
  • 38 Musselman DL, Tomer A, Manatunga AK. et al. Exaggerated platelet reactivity in major depression. Am J Psychiatry 1996; 153: 1313-1317.
    CrossrefPubMedGoogle Scholar
  • 39 Maes M, Van der Planken M, Van Gastel A. et al. Blood coagulation and platelet aggregation in major depression. J Affect Disord 1996; 40: 35-40.
    CrossrefPubMedGoogle Scholar
  • 40 Macleod J, Davey Smith G. Psychosocial factors and public health: a suitable case for treatment?. J Epidemiol Comm Health 2003; 57: 565-570.
    CrossrefPubMedGoogle Scholar
  • 41 Borch KH, Hansen-Krone I, Braekkan SK. et al. Physical activity and risk of venous thromboembolism. The Tromso study. Haematologica 2010; 95: 2088-2094.
    PubMedGoogle Scholar
  • 42 Tsai AW, Cushman M, Rosamond WD. et al. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of throm-boembolism etiology. Arch Intern Med 2002; 162: 1182-1189.
    CrossrefPubMedGoogle Scholar
  • 43 Lutsey PL, Virnig BA, Durham SB. et al. Correlates and consequences of venous thromboembolism: The Iowa Women's Health Study. Am J Public Health 2010; 100: 1506-1513.
    CrossrefPubMedGoogle Scholar
  • 44 Heit JA, O'Fallon WM, Petterson TM. et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162: 1245-1248.
    CrossrefPubMedGoogle Scholar
  • 45 Lyubomirsky S, King L, Diener E. The benefits of frequent positive affect: does happiness lead to success?. Psychol Bull 2005; 131: 803-855.
    CrossrefPubMedGoogle Scholar
  • 46 Clarke R, Shipley M, Lewington S. et al. Underestimation of risk associations due to regression dilution in long-term follow-up of prospective studies. Am J Epidemiol 1999; 150: 341-353.
    CrossrefPubMedGoogle Scholar