03157nas a2200385   4500008004100000022001400041245011800055210006900173260001600242300001000258490000800268520204900276653000902325653001502334653002402349653001102373653002202384653001802406653001102424653001402435653000902449653003102458653001402489653002602503653001702529653001802546653001802564100002902582700003002611700002702641700002402668700002402692700001902716856003602735       2011                        eng d  a1879-191300aPredictive value of depressive symptoms and B-type natriuretic peptide for new-onset heart failure and mortality.0 aPredictive value of depressive symptoms and Btype natriuretic pe  c2011 Mar 01  a723-90 v1073 a<p>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.</p>10aAged10aDepression10aDisease Progression10aFemale10aFollow-Up Studies10aHeart Failure10aHumans10aIncidence10aMale10aNatriuretic Peptide, Brain10aPrognosis10aRetrospective Studies10aRisk Factors10aSurvival Rate10aUnited States1 avan den Broek, Krista, C1 adeFilippi, Christopher, R1 aChristenson, Robert, H1 aSeliger, Stephen, L1 aGottdiener, John, S1 aKop, Willem, J  uhttps://chs-nhlbi.org/node/1268