Higher plasma levels of MR-pro-atrial natriuretic peptide are linked to less anxiety: results from the observational DIAST-CHF study

Abstract

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. A total of 1,360 patients from the observational DIAST-CHF study (mean age 65.9 +/- A 8.2 years, 48.7 % males, mean left ventricular ejection fraction 60.0 +/- A 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. Among the total study population, there were n = 117 patients (8.6 %) with HADS anxiety scores above the cut-off (a parts per thousand yen11) 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(beta) = 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(beta) = 0.67, 95 % CI 0.41-1.07, p = 0.094) failed to reach the significance level in independently predicting anxiety. 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.