The relationship between cardiac cachexia, depression, and immune-inflammation in Hispanic and non-Hispanic patients with chronic heart failure.

摘要

The dissertation describes three studies that examined the relationships between depressive symptoms and cardiac cachexia (CC), socioeconomic status (SES), and biologic correlates in patients with chronic heart failure (CHF).;Analyses conducted to answer the specific aims of this dissertation showed that in 55 CHF patients 9% (n=5) had major depression (Patient-Health Questionnaire (PHQ)-9 ≥ 10) whereas 40% (n=22) had mild to severe moderate depressive symptoms (PHQ-9 ≥ 5). Subjects with and without depressive symptoms were equivalent in terms of sociodemographic, clinical, anthropometric, and biologic characteristics. Multivariate analysis showed that New York Heart association class (NYHA) (beta=.374; p=.025), perceived stress (beta=.292; p=.029), and soluble tumor necrosis factor receptor-2 (sTNFR2) (beta=.347; p=.028), but neither CC nor SES were predictors of depressive symptoms independent of age, gender, ejection fraction (EF), C-reactive protein, interleukin-6, and CC. These variables predicted 33.9% of the variance in depressive symptoms.;One study was performed using data on 114 patients from the Heart Failure Patient Quality of Life Registry. The findings in this study showed that higher depressive symptoms (Odds Ratio [OR]=1.32; Confidence Interval [CI]=1.02-1.5; p=.035) and lower EF (OR=0.83; CI=0.71-0.98; p=.031) were related of CC independent of age, gender, body mass index (BMI), and functional status.;Results from the second study showed no significant differences in levels of pro-inflammatory cytokines among patients with and without depressive symptoms. Higher levels of low density lipoprotein-cholesterol (LDL-C, p=.004) and triglycerides (TG, p=.020) and total cholesterol/high density lipoprotein cholesterol ratio (TC/HDL-C, p=.026) were observed in the depressive symptoms group. In multivariate analyses, after controlling for age, gender, BMI, EF, antidepressants, and statin use, sTNFR2 was an independent predictor of depressive symptoms. In separate multivariate analyses including these covariates as independent variables and different lipid parameters showed that LDL-C was an independent correlate of depressive symptoms.