Plasma mid-regional pro-adrenomedullin levels are inversely associated with anxiety but unrelated to depression: Results from the observational DIAST-CHF study in patients with cardiovascular risk factors.
OBJECTIVE
It has been postulated that patients with heart failure have a high risk of ventricular arrhythmias and sudden cardiac death resulting from anxiety-induced autonomic arousal. In the prospective and multicenter DIAST-CHF (Diagnostic Trial on Prevalence and Clinical Course of Diastolic Dysfunction and Heart Failure) study, we therefore, tested the hypothesis that adrenomedullin (ADM), a well-established predictor for cardiovascular outcome, is associated with self-rated anxiety symptoms in patients at risk of suffering from or actually with overt heart failure.


METHODS
Study participants with risk factors for diastolic dysfunction were requested to complete the Hospital Anxiety and Depression Scale (HADS), and plasma mid-regional pro-adrenomedullin (MR-proADM) concentrations were measured.


RESULTS
In bivariate analysis, we found significantly lower plasma MR-proADM levels in patients with elevated HADS-anxiety scores above the clinically relevant cut-off level of ≥11 (n=118, 536pmol/l, interquartile range [IQR] 449-626) as compared to non-anxious study participants (n=1,292, 573pmol/l, IQR 486-702, p=0.001). A set of multivariate models adjusted for potential confounders confirmed the negative association between self-rated anxiety symptoms and plasma MR-proADM. In similar models, no significant association was detected between HADS-depression scores and MR-proADM.


CONCLUSIONS
The inverse relationship between plasma MR-proADM and anxiety observed in patients with cardiovascular risk factors supports a previous experimental study using a mutant mouse line with a brain-specific loss of ADM expression which displayed hyperactive and over-anxious behavior. Further experimental and clinical studies are warranted to test the hypothesis that also in humans ADM acts as a neuromodulator with anxiolytic properties.
Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany; German Centre for Cardiovascular Research, Germany.
Thomas
T
Meyer
Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany; German Centre for Cardiovascular Research, Germany.
Christoph
C
Herrmann-Lingen
Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany; German Centre for Cardiovascular Research, Germany.
Mira-Lynn
ML
Chavanon
Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany; German Centre for Cardiovascular Research, Germany.
Burkert
B
Pieske
Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany; German Centre for Cardiovascular Research, Germany.
Rolf
R
Wachter
Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany; Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany; German Centre for Cardiovascular Research, Germany. Electronic address: fedelmann@med.uni-goettingen.de.
Frank
F
Edelmann
D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000097:blood* / Q000175:diagnosis; D002318:Cardiovascular Diseases / Q000097:blood*; D003863:Depression / Q000097:blood* / Q000175:diagnosis; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
C507862:ADM protein, human; D053607:Adrenomedullin
Adrenomedullin; Anxiety; Cardiovascular risk factors; Depression; Diastolic dysfunction