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. (December 2015)

• Record Type: Journal Article
• Authors: Meyer, Thomas; Herrmann-Lingen, Christoph; Chavanon, Mira-Lynn; Pieske, Burkert; Wachter, Rolf; Edelmann, Frank
• Is Part Of: Psychoneuroendocrinology. Volume 62(2015:Dec.)
• Page Start: 227
• Page End: 232
• Publication Date: 2015-12
• Subjects: Adrenomedullin -- Anxiety -- Depression -- Cardiovascular risk factors -- Diastolic dysfunction; Psychoneuroendocrinology -- Periodicals; Endocrinology -- Periodicals; Neurology -- Periodicals; Psychiatry -- Periodicals; Neuropsychoendocrinologie -- Périodiques; 616.8
• DOI: 10.1016/j.psyneuen.2015.08.007
• Languages: English
• ISSNs: 0306-4530

Abstract

Highlights: Data from the multicenter DIAST-CHF study in patients with cardiovascular risk factors ( n = 1, 410) demonstrated that elevated plasma mid-regional pro-adrenomedullin (MR-proADM) levels are linked to less severe anxiety symptoms. The inverse association between MR-proADM and anxiety remained stable after adjustment for potential confounders, irrespective of whether continuous or dichotomized HADS (Hospital Anxiety and Depression Scale) anxiety scores above the clinically relevant cut-off level were used. Our clinical findings in a human sample support data from a previous animal study showing over-anxious behavior in a conditional knock-out mouse line lacking brain-specific expression of ADM. Abstract: Objectives: 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. Participants and measures: 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, 536 pmol/l, interquartile range [IQR] 449–626) as compared to non-anxious study participants ( n = 1, 292, 573 pmol/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.