Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Von-Siebold-Str. 5, 37075 Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany.
Department of Psychosomatics and Psychotherapy, University of Cologne, Kerpener Str. 63, 50937 Cologne, Germany.
J Psychosom Res. 2019 Aug;123:109728. doi: 10.1016/j.jpsychores.2019.05.006. Epub 2019 May 21.
Patients with coronary heart disease (CHD) suffer from physical limitations, but also from psychological distress. Natriuretic peptides may be involved in the neurobiological processes that modulate psychological adaptation, as they are increased in heart disease and seem to have an anxiolytic-like function. Longitudinal data on this association are scarce.
To assess the relationship between NT-proBNP and anxiety (Hospital Anxiety and Depression Scale (HADS)), we used secondary data from a multicenter trial from baseline to 24 months. Patients (N = 308, 80.8% male, mean age 60.1 years) had stable CHD and moderate levels of depression (HADS ≥8).
Multiple linear regression adjusted for age, sex, BMI, and physical functioning revealed NT-proBNP as a significant predictor for anxiety at baseline, 1, 6, 12, 18, and 24 months (all p < .05). Linear mixed model analysis with the six anxiety measures as level-1 variable and NT-proBNP as fixed factor revealed a significant timeNT-proBNP interaction (t(1535.99) = -2.669, p = .01) as well as a significant timeNT-proBNP*sex interaction (t(1535.99) = 3.277, p = .001), when NT-proBNP was dichotomized into lowest vs. the three highest quartiles.
Our results indicate a stable negative association of baseline NT-proBNP with anxiety over two years. In men and women, different pathways modulating this relationship appear to be in effect. Female patients with very low NT-proBNP levels, despite their cardiac disease, show persistently higher levels of anxiety compared to women with higher levels of NT-proBNP and compared to men. Trial name: A Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD).
www.clinicaltrials.govNCT00705965; www.isrctn.com ISRCTN76240576.
冠心病（CHD）患者不仅身体受限，还伴有心理困扰。利钠肽可能参与调节心理适应的神经生物学过程，因为它们在心脏病中增加，并且似乎具有抗焦虑样作用。关于这种关联的纵向数据很少。
为了评估 NT-proBNP 与焦虑（医院焦虑和抑郁量表（HADS））之间的关系，我们使用了来自多中心试验的二次数据，从基线到 24 个月。患者（N=308，80.8%为男性，平均年龄 60.1 岁）患有稳定的 CHD 和中度抑郁（HADS≥8）。
调整年龄、性别、BMI 和身体功能的多元线性回归显示，NT-proBNP 是基线、1、6、12、18 和 24 个月时焦虑的显著预测因子（均 p<.05）。将 6 项焦虑测量作为水平-1 变量，NT-proBNP 作为固定因素的线性混合模型分析显示，时间NT-proBNP 交互作用具有统计学意义（t(1535.99)=-2.669，p=.01），时间NT-proBNP*性别交互作用也具有统计学意义（t(1535.99)=3.277，p=.001），当 NT-proBNP 分为最低和三个最高四分位时。
我们的结果表明，基线 NT-proBNP 与两年内的焦虑呈稳定的负相关。在男性和女性中，调节这种关系的不同途径似乎在起作用。尽管患有心脏病，但 NT-proBNP 水平非常低的女性患者，与 NT-proBNP 水平较高的女性患者和男性患者相比，焦虑水平持续较高。试验名称：逐步心理干预降低冠心病风险（SPIRR-CAD）。
www.clinicaltrials.govNCT00705965；www.isrctn.comISRCTN76240576。
