Predictive Value of Depressive Symptoms and B-Type Natriuretic Peptide for New-Onset Heart Failure and Mortality

• Published in: The American journal of cardiology Vol. 107; no. 5; pp. 723 - 729
• Main Authors: van den Broek, Krista C., deFilippi, Christopher R., Christenson, Robert H., Seliger, Stephen L., Gottdiener, John S., Kop, Willem J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier; Elsevier Limited
• Subjects: Adult and adolescent clinical studies; Aged; Biological and medical sciences; Biomarkers; Cardiology; Cardiology. Vascular system; Cardiovascular; Depression; Depression - blood; Depression - epidemiology; Depression - etiology; Disease Progression; Female; Follow-Up Studies; Heart; Heart failure; Heart Failure - blood; Heart Failure - complications; Heart Failure - epidemiology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Immunoassay; Incidence; Male; Medical sciences; Mental depression; Miscellaneous; Mood disorders; Mortality; Natriuretic Peptide, Brain - blood; Peptides; Prognosis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Risk Factors; Survival Rate - trends; United States - epidemiology; United States; Mood disorder; Heart failure; Type; Prognosis; Peptides; Heart disease; Mortality; Predictive value; Cardiovascular disease; Depression; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2010.10.055

Depression and natriuretic peptides predict heart failure (HF) progression, but the unique contributions of depression and biomarkers associated with HF outcomes are not known. The present study determined the additive predictive value of depression and aminoterminal pro-B-type natriuretic peptide (NT-proBNP) for new-onset HF in HF-free subjects and mortality in patients with HF. The participants in the Cardiovascular Health Study were assessed for depressive symptoms using the Center for Epidemiologic Studies Depression Scale and NT-proBNP using an electrochemiluminescence immunoassay. The validated cutoff values for depression (Center for Epidemiologic Studies Depression Scale ≥8) and NT-proBNP (≥190 pg/ml) were used. The risks of incident HF and mortality (cardiovascular disease-related and all-cause) were examined during a median follow-up of 11 years, adjusting for demographics, clinical factors, and health behaviors. In patients with HF (n = 208), depression was associated with an elevated risk of cardiovascular disease mortality (hazard ratios [HR] 2.07, 95% confidence interval [CI] 1.31 to 3.27) and all-cause mortality (HR 1.49, 95% CI 1.05 to 2.11), independent of the NT-proBNP level and covariates. The combined presence of depression and elevated NT-proBNP was associated with substantially elevated covariate-adjusted risks of cardiovascular disease mortality (HR 5.42, 95% CI 2.38 to 12.36) and all-cause mortality (HR 3.72, 95% CI 2.20 to 6.37). In the 4,114 HF-free subjects, new-onset HF was independently predicted by an elevated NT-proBNP level (HR 2.27, 95% CI 1.97 to 2.62) but not depression (HR 1.08, 95% CI 0.92 to 1.26) in covariate-adjusted analysis. In conclusion, depression and NT-proBNP displayed additive predictive value for mortality in patients with HF. These associations can be explained by complementary pathophysiologic mechanisms. The presence of both elevated depression and NT-proBNP levels might improve the identification of patients with HF with a high risk of mortality.