Abstract
Aims: Alexithymia has been linked to cardiovascular disease. The aim was to explore whether the immuno-inflammatory variables galectin-3 binding protein (Gal3BP), soluble (s)CD163 and galectin-3 were independently associated with alexithymia, while controlling for known risk factors for cardiovascular disease, such as depression, anxiety, impaired glycemic control, obesity, smoking, and physical inactivity in patients with type 1 diabetes (T1D).Methods: Cross-sectional design. The participants were consecutively recruited from one diabetes out-patient clinic. Alexithymia, depression and anxiety were assessed by self-report instruments. Blood samples, anthropometrics, and blood pressure were collected, supplemented with data from electronic health records. High Gal3BP was defined as ≥3.3 μg/ml, high sCD163 as ≥0.6 μg/ml, high galectin-3 as ≥2.6 ng/ml, impaired glycemic control as HbA1c >70 mmol/mol (>8.6%) and abdominal obesity as waist circumference ≥ 1.02 m for men and ≥ 0.88 m for women.Results: Two hundred and ninety two patients participated (men 56%, aged 18–59 years, alexithymia prevalence 15%). Patients with alexithymia had higher prevalence of depression (34 vs. 6%, p < 0.001), anxiety (61 vs. 30%, p < 0.001), high Gal3BP levels (39 vs. 17%, p = 0.004), high HbA1c levels (46 vs. 24%, p = 0.006), and abdominal obesity (29 vs. 15%, p = 0.045). Depression [adjusted odds ratio (AOR) 6.5, p < 0.001], high Gal3BP levels (AOR 2.4, p = 0.035), and age (AOR 0.96, p = 0.027) were independently associated with alexithymia. Abdominal obesity (AOR 4.0, p < 0.001), high Gal3BP levels (AOR 2.8, p = 0.002), and depression (AOR 2.9, p = 0.014) were associated with high HbA1c. Abdominal obesity and anxiety were associated [Crude odds ratio (COR) 2.4, p = 0.006].Conclusions: T1D patients with alexithymia had higher prevalence of high Gal3BP levels, depression, impaired glycemic control, anxiety, and abdominal obesity, which are known risk factors for cardiovascular disease. Only high Gal3BP levels, depression, and younger age were independently associated with alexithymia in adult patients with T1D.
Highlights
Alexithymia literally denotes “no words for feelings.” Alexithymia is a state or personality trait characterized by limited ability to identify and describe feelings, and to distinguish between sensations in the body caused by emotional arousal and sensations of other origins [1,2,3]
Comparisons showed that the patients with alexithymia compared to the patients without alexithymia had 5.7 times higher prevalence of depression (34 vs. 6%, p < 0.001), twice as high prevalence of anxiety (61 vs. 30%, p < 0.001), 1.9 times higher prevalence of abdominal obesity (29 vs. 15%, p = 0.045), and 3.2 times higher prevalence of combined anxiety and abdominal obesity (21 vs. 6.5%)
Comparisons showed that the patients with alexithymia compared to the patients without alexithymia had 2.3 times higher prevalence of high Galectin-3 binding protein (Gal3BP) (39 vs. 17%, p = 0.004), 1.7 times higher prevalence of high sCD163 (30 vs. 18%, p = 0.095), and 1.9 times higher prevalence of high HbA1c (> 70 mmol/mol) (46 vs. 24%, p = 0.006)
Summary
Alexithymia literally denotes “no words for feelings.” Alexithymia is a state or personality trait characterized by limited ability to identify and describe feelings, and to distinguish between sensations in the body caused by emotional arousal and sensations of other origins [1,2,3]. Increased baseline levels of sympathetic activity and disturbances of the hypothalamo-pituitary-adrenal (HPA) axis have been demonstrated in persons with alexithymia [2, 3]. Disturbances of the immune system, involving monocytes and macrophages, contribute to the development of atherosclerosis and cardiovascular disease [19,20,21,22,23,24,25]. Galectin-3 binding protein (Gal3BP) is a macrophage scavenger receptor which, while activated, induces a number of pro-inflammatory cytokines [21]. Increased plasma levels of Gal3BP have been linked to metabolic disturbances [27], to recurrent angina/myocardial infarction [22], and to cardiovascular and all-cause mortality [21]. Galectin-3 has been linked to depression [31, 32], heart failure [24], coronary artery disease [25], and all-cause mortality [22]
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