C-reactive protein and fibrinogen in non-obstructive coronary artery disease as related to depressive symptoms and anxiety: Findings from the TweeSteden Mild Stenosis Study (TWIST)

Abstract Objective The majority of acute coronary syndromes occur in the absence of obstructive coronary artery disease (CAD), and the underlying biobehavioral processes are not well understood. Depressive symptoms and anxiety are predictive of prognosis, and have been associated with markers of inflammation that play a role in atherosclerosis. This study examines whether depressive symptoms and anxiety are associated with higher levels of high-sensitive C-reactive protein (hs-CRP) and fibrinogen in patients with non-obstructive CAD. Methods Patients with non-obstructive CAD (“wall irregularities”, stenosis < 60%, N = 414, mean age 62.1 ± 9.3 years, 52% women) in the TweeSteden Mild Stenosis (TWIST) observational cohort study completed the Hospital Anxiety and Depression Scale (HADS). Blood samples were analyzed for hs-CRP and fibrinogen. The cross-sectional association of anxiety and depressive symptoms with hs-CRP and fibrinogen, adjusting for covariates, was examined by multivariate regression analysis. Results Depressive symptoms were positively associated with hs-CRP level (β = .135, p = .009), but not fibrinogen (β = .075, p = .153), adjusted for age and sex. Additional adjustments for sociodemographic, disease severity and lifestyle factors rendered the association non-significant. In the fully adjusted model, depressive symptoms were not associated with hs-CRP (β = .036, p > 0.10) and BMI was the only variable that was independently associated with hs-CRP (β = .203, p < .001). No associations were observed for anxiety with either hs-CRP or fibrinogen (p > 0.10). Conclusion Among patients with non-obstructive CAD, depressive symptoms and anxiety were not independently associated with hs-CRP and fibrinogen.