Abstract 13659: Depressive Symptoms are Associated with Higher Levels of Inflammatory Biomarkers in Patients with Heart Failure
Background: Depressive symptoms independently predict mortality and morbidity in patients with heart failure (HF). Inflammation may be a mechanistic link between depressive symptoms and poor outcomes, but few researchers have reported inflammation levels among HF patients with and without depressive symptoms.
Purpose: To compare levels of inflammatory biomarkers between HF patients with and without depressive symptoms.
Methods: We analyzed data from 476 outpatients enrolled in a multicenter HF registry (33% female, 61.5 ± 11.5 yrs, 44% NYHA Class III/IV) who had data on depressive symptoms and inflammation. Depressive symptoms were measured with the Beck Depression Inventory-II; scores >13 indicate depressive symptoms. Serum C-reactive protein (CRP), uric acid, cytokines (interleukin [IL] 1RA, 2, 4, 6, 8, 10), tumor necrosis alpha (TNFα), and soluble receptors sTNFR1 and sTNFR2 were measured with enzyme immunoassay. Biomarker data were log-transformed prior to use of independent sample t-tests or analyzed using the non-parametric Mann Whitney U test. Chi-square tests were used to compare the proportion of patients with and without depressive symptoms who have biomarker levels above the median and 75th percentile.
Results: Twenty-seven percent (n = 124) had depressive symptoms. Patients with depressive symptoms had higher median levels of CRP (3.7 [25th percentile = 1.7, 75th percentile = 9.3] vs. 2.3 [1.2, 5.4], p = .005) and higher median levels of anti-inflammatory IL-10 (5.7 [1.5, 11.5] vs. 3.4 [.53, 8.2], p = .02) compared to patients without depressive symptoms. Patients with depressive symptoms had a higher proportion above the median level for CRP (66% vs. 44%, p = .001), as well as a higher proportion of patients above the 75th percentile for sTNFR2 (32% vs. 23%, p = .03) and IL-10 (35% vs. 21%, p = .03). No other biomarker levels differed between the two groups.
Conclusions: Patients with HF and depressive symptoms have higher levels of inflammation as measured with CRP and sTNFR2, which may explain why they also have higher levels of anti-inflammatory cytokine IL-10. These data suggest that inflammation may mediate the relationship between depressive symptoms and poor outcomes in patients with HF; however, future research is needed to confirm this.
- © 2011 by American Heart Association, Inc.