Anxiety predicts heart disease decades into the future

Two studies link anxiety but not depression to cardiovascular risk for coronary heart disease later in life.

In the studies, anxiety disorders predicted heart disease even after controlling for baseline differences in blood pressure, smoking, and other potential risk factors for coronary heart disease (CHD). Both studies appear in the June 29 Journal of the American College of Cardiology.

In one of the studies, a meta-analysis combined 20 prospective studies reporting on incident cardiac events and included 249,846 persons with a mean follow-up period of 11.2 years.

Anxious persons were at risk of CHD (hazard ratio [HR] random, 1.26; 95% CI, 1.15 to 1.38; P<0.0001) and cardiac death (HR, 1.48; 95% CI, 1.14 to 1.92; P=0.003), independent of demographic variables, biological risk factors and health behaviors. Subgroup analyses did not show any significant differences regarding study characteristics, with significant associations for different types of anxiety, short- and long-term follow-up, and both men and women.

A second study confirmed the role of anxiety as a strong predictor of future cardiac events. This 37-year follow-up involved 49,321 young Swedish men who were medically examined for military service in 1969 and 1970, when they were 18 to 20 years of age. Psychologists interviewed all men, and psychiatrists saw all men reporting or presenting any symptoms. Data on well-established CHD risk factors and potential confounders were also collected, including smoking, alcohol consumption, body mass index, family history of heart disease, diabetes, blood pressure and physical activity.

Multiadjusted HRs for anxiety were 2.17 (95% CI, 1.28 to 3.67) for CHD and 2.51 (95% CI, 1.38 to 4.55) for acute myocardial infarction. Multiadjusted HRs associated with depression were 1.04 (95% CI, 0.70 to 1.54) for CHD and 1.03 (95% CI, 0.65 to 1.65) for acute myocardial infarction.

An editorial noted how the two studies should guide clinical practice currently: "... By the time patients with symptoms of CHD present themselves to a cardiologist, early-life anxiety might have already taken its toll."

Assessment tools are readily available, have easy-to-ask questions and might be relevant for diagnosing and preventing CHD. But, the editorialist continued, "Physicians are frequently timid about assessing emotional symptoms. It is odd that we thread catheters, ablate lesions, and give rectal exams but are uncomfortable asking our patients about their lives."