Association between psychological measures and brain natriuretic peptide in heart failure patients

Abstract

Objective. Brain natriuretic peptide (BNP) is a promising marker for heart failure diagnosis and prognosis. Although psychological factors also influence heart failure (HF) prognosis, this might be attributed to confounding by BNP. Our aim was to examine the association between multiple psychological markers using a prospective study design with repeated N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements. Design. The sample comprised 94 outpatients with systolic HF (80% men; mean age =62.2±9.3). The psychological markers (i.e., anxiety, depression, and Type D personality), assessed with the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI), and the Type D Scale (DS14) were assessed only at baseline. Plasma NT-proBNP levels were measured at baseline and at 9 months. Results. The prevalence of anxiety, depression, and Type D personality at baseline was 23.4% (HADS-A), 17.0% (HADS-D), 46.6% (BDI), and 21.3% (DS14), respectively. At baseline, none of the psychological risk markers were associated with NT-proBNP levels (all p >.05). In the subset of patients with scores on psychological risk markers both at baseline and at 9 months, there were no association between anxiety (p =0.44), depression (HADS-D: p =0.90; BDI: p =0.85), and Type D (p =0.63) with NT-proBNP levels using ANOVA for repeated measures. Conclusions. Our findings indicate that measures frequently used in HF to assess psychological risk markers are unconfounded by NT-proBNP. Futher studies are warranted to replicate these findings and examine whether psychological risk markers are independent predictors of prognosis in HF or an artifact that may be attributed to other biological or behavioral mechanisms.

Key words::

• brain natriuretic peptide
• chronic heart failure
• confounding
• psychological factors

Acknowledgments

We would like to thank Dr. Aage Nørgaard, Dr. Jens Berning, Bente Mortensen, Linda Lund, Anne Marie Laustsen, Britta Rosborg Wegener, Janne Milton, Jane Petersen, Helle Arnsted, and Charlotte Anker for their involvement in the study.

This research was in part supported by the Danish Heart Foundation (grant no. 03-2-9-9-22092 and 06-4-B505-22283F) and with a VIDI grant (91710393) from the Netherlands Organisation for Health Research and Development (ZonMw), the Hague, the Netherlands, to Dr. Susanne S. Pedersen.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.