Transcript Titel

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Inflammation, Mediation and Type D personality
Multiple inflammatory biomarkers as mediators between Type D personality and course
of 18 month health status in patients with heart failure. Brain Behav Immun 2011;Sep 29
Center of Research
on Psychology
in Somatic diseases
Paula Mommersteeg, PhD
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Contributors
• Aline Pelle PhD, CoRPS, Tilburg University
• Christian Ramakers PhD, Clinical Chemistry and
Hematology Laboratory, St. Elisabeth Hospital,
Tilburg
• Balázs M. Szabó MD PhD, Department of
Cardiology, St. Elisabeth Hospital, Tilburg,
• Johan Denollet PhD, CoRPS, Tilburg University
• Nina Kupper PhD, CoRPS, Tilburg University
Project on patients with Heart Failure
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What ?
Type D personality
Inflammation
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Type D personality
•
•
•
•
•
Distressed
Negative affectivity
Social inhibition
Prevalence 13-25%
Stable construct
Denollet, J. (2005). Psychosom Med, 67(1), 89-97
Denollet et al (2010). Circ Cardiovasc Qual Outcomes, 3(5), 546-557
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Meta-analysis – Cardiac mortality, MI, MACE
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Meta-analysis – …Health status
Denollet et al (2010). Circ Cardiovasc Qual Outcomes, 3(5), 546-557
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Health status – poor prognosis
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Inflammation and health status?
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Health status, inflammation & prognosis
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Type D, health status, inflammation
How ?
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How ?
Mediation!
Type D personality
Inflammation
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Mediation
A. Total effect
Type D
Personality
B. Mediation
a
Type D
personality
c
Health status
Inflammation
c’
b
Health status
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Mediation - challenge
Many ingredients
– Type D personality: subscales negative affectivity (NA) and
social inhibition (SI)
- Multiple inflammatory variables: IL-6, hsCRP, TNFα,
sTNFr1, sTNFr2
- Health status: physical, mental and disease specific
- Multiple outcome assessment: health status at 0, 6, 12 and
18 months
- Optimal use of these ingredients
Figure 1.
•Model 1
•Model 2
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Multiple Mediation
IL-6
E HS
bIL-6
aIL-6
E NA
hsCRP
NA
bCRP
aCRP
Type D
C’
aTNF-?
E SI
Health status
bTNF-?
SI
TNF-?α
ar1
br1
ar2
br2
sTNFr1
E IL-6 **
E CRP**
ETNF- ?**
sTNFr2
E r1**
E r2 **
* Names of paths correspond with path loading estimates presented in Table4.
** All error terms of inflammatory biomarkers were allowed to correlate in Model
2.
Preacher, K. J. and A. F. Hayes (2008). Behavior research methods 40(3): 879-91.
A. Model 1
HS 0 months
HS
baseline
*
1
1
(intercept
)
Ci
1
NA
**
Type D
0
HS 12 months
1
Cs
SI
HS 6 months
1
2
HS
change
(slope)
HS 18 months
3
HS 0 months
HS
baseline
B. Model 2
*
**
Type D
Cs ’
bsIL-6
IL-6
aTNF
ar1
bsCRP
biCRP
CRP
TNF-α
ar2 sTNFr1
sTNFr2
bsTNF
biTNF
bir1
bir2
0
HS 12 months
1
2
biIL-6
aCRP
HS 6 months
1
1
NA
aIL-6
1
(intercept
)
Ci ’
SI
1
bsr1
bsr2
HS
change
(slope)
3
HS 18 months
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What did we find?
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C-pathways; intercept and slope
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C-pathways; intercept and slope
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C’pathways; intercept
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C’pathways; slope
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The model showed that
• Type D was associated with
– poor health status
– deterioration of mental health status over time
– increased levels of TNFα and sTNFr2
Increased inflammatory variables were associated with
– poor baseline health status and change in health
status
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…was there mediation?
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Mediation ?
• Physical health status:
– Intercept/baseline (Zi = 0.573, pi = 0.283): No
– Slope/ change (Zs = 1.948, ps = 0.026): Yes
• Mental health status:
– Intercept/baseline (Zi = 0.977, pi = 0.164): No
– Slope/ change (Zs = 1.525, ps = 0.064): Possibly
• Disease specific health status:
– Intercept/baseline (Zi = 0.591, pi = 0.277): No
– Slope/ change (Zs = 1.131, ps = 0.129): Not likely
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Mediation ?
• The association between Type D personality and health
status in patients with heart failure is NOT LIKELY
mediated by multiple inflammatory biomarkers
– Strongest case for physical health status
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•
•
•
But: group didn’t show a lot of change over time
Sample size was restricted (N= 228 max)
M-plus is better at analysing a complex model like this
What about depression or anxiety?
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Take home message
• Multiple mediation analysis: innovative
– Use in other fields with multiple assessments
• Type D personality is associated with poor health status
• Inflammatory factors are associated with poor health
status ….
• …but they are not likely to mediate this association
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Mommersteeg et al. “Type D personality and course of health status over 18 months in
outpatients with heart failure: multiple mediating inflammatory biomarkers.”
Brain Behav Immun 2011;Sep 29. [Epub ahead of print].
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Correlations
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C-path; Type D – Health status
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a-path; Type D - Inflammation
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b-path; inflammation – health status
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Are they associated?
• Correlation