Study Question:
Does anxiety increase the risk of coronary heart disease (CHD)?
Methods:
This was a meta-analysis using references from MEDLINE, EMBASE, and PSYCINFO from 1980 to May 2009. Selection criteria included prospective studies using nonpsychiatric cohorts, in which anxiety was assessed at baseline. All subjects were apparently healthy, with no known cardiac disease. Studies that focused on people over the age of 75 years were excluded. Outcomes of interest included cardiac death, myocardial infarction (MI), and cardiac events.
Results:
A total of 3,243 abstracts were reviewed, of which 63 studies met eligibility criteria for review of the full text. Twenty studies were included, which comprised 249,846 persons with a mean follow-up of 11.2 years. The mean age at baseline in these studies ranged from 38 years to 72 years. Anxiety was associated with an increased risk for CHD (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.15-1.38) and cardiac death (HR, 1.48; 95% CI, 1.14-1.92), after adjustment for demographic factors, biological risk factors, and health behaviors. A nonsignificant trend toward increased risk was observed for nonfatal MI (HR, 1.43; 95% CI, 0.85-2.40). In subgroup analysis, no significant differences were observed for different types of anxiety, length of follow-up, or gender.
Conclusions:
The authors concluded that anxiety appears to be an independent risk factor of CHD, in particular, CHD mortality.
Perspective:
As the authors suggest, further research on anxiety as it relates to CHD is warranted. Studies are needed to further our understanding regarding the mechanistic aspects of anxiety and CHD, as well as interventional trials to reduce CHD by treatment of anxiety.
Author(s):
Elizabeth A. Jackson, M.D., F.A.C.C. (Disclosure)
Topic(s):
Prevention/Vascular, General Cardiology