Prolonged elevations in haemostatic

There is a marked socioeconomic gradient in the incidence of coronary heart disease (CHD) and in subclinical atherosclerosis (1, 2). Haemostatic and rheological factors may contribute to this pattern. Socioeconomic gradients in fibrinogen have been described in the Whitehall II study (3) and in other cohorts (4, 5). Socioeconomic status (SES) is also inversely associated with the concentration of von Willebrand factor (vWF) antigen (4-7), and associations between low SES and raised levels of coagulation Factor VIII and plasma viscosity have been described (6, 8, 9). No association with SES has been observed for activated Factor VII or plasminogen activator inhibitor-1 (5), while evidence concerning relationships with blood viscosity, tissue plasminogen activator (t-PA) and fibrin D-dimer is very limited. Haemostatic factors are also sensitive to chronic and acute psychological stress (10). It has been postulated that one mechanism by which low SES status might increase cardiovascular disease risk is through activation of stress-related neuroendocrine and autonomic pathways (11). We therefore examined SES variations in haemostatic and rheological factors both at rest, and in response to psychological stress, in a sub-sample of the Whitehall II epidemiological cohort. We hypothesized that stress would induce a hypercoagulable state that was more pronounced in lower SES participants. We have recently observed that lower SES is associated with impaired blood pressure and heart rate recovery following stress (12), and postulated that a similar pattern might be present for haemostatic variables. There are marked variations in cardiovascular stress reactions between individuals (13), so the association between changes in haemo83 © 2003 Schattauer GmbH, Stuttgart