title: Higher plasma levels of MR-pro-atrial natriuretic peptide are linked to less anxiety: results from the observational DIAST-CHF study.
abstract: OBJECTIVE
  Growing evidence suggests that natriuretic peptides play a role in the neurobiology of anxiety. In the present study, we investigated whether in patients with cardiovascular risk factors higher plasma levels of natriuretic peptides are linked to reduced anxiety.
  
  
  METHODS
  A total of 1,360 patients from the observational DIAST-CHF study (mean age 65.9 ± 8.2 years, 48.7 % males, mean left ventricular ejection fraction 60.0 ± 8.2 %) with risk factors for diastolic heart failure were included. Study participants underwent physical examination, echocardiography, and assessment of anxiety using the Hospital Anxiety and Depression Scale (HADS). In addition, plasma concentrations of natriuretic peptides were measured.
  
  
  RESULTS
  Among the total study population, there were n = 117 patients (8.6 %) with HADS anxiety scores above the cut-off (≥11) suggestive of clinically relevant anxiety. In bivariate analyses, we found a significant inverse association between elevated HADS anxiety and log-transformed mid-regional pro-atrial natriuretic peptide (MR-proANP) (p < 0.001) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) (p = 0.008). Logistic regression models adjusted for sex, age, body mass index, and Framingham score confirmed that plasma MR-proANP (exp(β) = 0.35, 95 % confidence interval [95 % CI] 0.14-0.92, p = 0.032) concentrations were significantly and inversely associated with clinically relevant anxiety, while NT-proBNP (exp(β) = 0.67, 95 % CI 0.41-1.07, p = 0.094) failed to reach the significance level in independently predicting anxiety.
  
  
  CONCLUSIONS
  In our study population of outpatients with cardiovascular risk factors, plasma concentrations of MR-proANP were negatively and independently related to clinically relevant anxiety. Further investigations are required to search for possible anxiolytic effects of this circulating natriuretic peptide in medical outpatients with cardiovascular risk factors for diastolic dysfunction.
authors: Department of Psychosomatic Medicine and Psychotherapy, German Centre for Cardiovascular Research, University of Göttingen, Göttingen, Germany, thomas.meyer@med.uni-goettingen.de.
authors: Thomas
authors: T
authors: Meyer
authors: Christoph
authors: C
authors: Herrrmann-Lingen
authors: Mira-Lynn
authors: ML
authors: Chavanon
authors: Kathleen
authors: K
authors: Nolte
authors: Caroline Anna
authors: CA
authors: Pasedach
authors: Lutz
authors: L
authors: Binder
authors: Burkert
authors: B
authors: Pieske
authors: Gerd
authors: G
authors: Hasenfuss
authors: Rolf
authors: R
authors: Wachter
authors: Frank
authors: F
authors: Edelmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000097:blood* / Q000453:epidemiology* / Q000523:psychology; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor