Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

Abstract

Background: Anxiety disorders increase risk of future cardiovascular disease (CVD) and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV), may be one mechanism linking anxiety disorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis.Method: Studies comparing resting-state HRV recordings in patients with an anxiety disorder as a primary diagnosis and healthy controls were considered for meta-analysis.Results: Meta-analyses were based on 36 articles, including 2086 patients with an anxiety disorder and 2294 controls. Overall, anxiety disorders were characterized by lower HRV [high frequency (HF): Hedges’ g = −0.29. 95% CI: −0.41 to −0.17, p < 0.001; time domain: Hedges’ g = −0.45, 95% CI: −0.57 to −0.33, p < 0.001] than controls. Panic disorder (n = 447), post-traumatic stress disorder (n = 192), generalized anxiety disorder (n = 68), and social anxiety disorder (n = 90), but not obsessive–compulsive disorder (n = 40), displayed reductions in HF HRV relative to controls (all ps < 0.001).Conclusion: Anxiety disorders are associated with reduced HRV, findings associated with a small-to-moderate effect size. Findings have important implications for future physical health and well-being of patients, highlighting a need for comprehensive cardiovascular risk reduction.

Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond

“…Similarly, studies have described decreased HRV in GAD (Thayer et al, 1996), social anxiety (Alvares et al, 2013), and specific phobia (Bornas et al, 2006). A recent meta-analysis concluded that all these anxiety disorders are all associated with reduced HRV (Chalmers et al, 2014). Taken together, the heightened sympathetic tone and reduction in parasympathetic activity, as well as the likely dysregulation of the HPA axis in anxiety disorders could lead to increased inflammation (Table 2) via similar pathways to those discussed above in the context of PTSD.…”

Heart rate variability is enhanced in controls but not maladaptive perfectionists during brief mindfulness meditation following stress-induction: A stratified-randomized trial

“…Exclusion criteria included a history or current diagnosis of any anxiety disorder and/or major depressive disorder and cardiovascular disease (hypertension, coronary artery disease, and arrhythmias) as these conditions are known to involve ANS dysfunction (Chalmers et al, 2014;Haensel et al, 2008;Kemp et al, 2012;Marano et al, 2009;Miu et al, 2009). Participants were excluded if they had a history of practicing mindfulness meditation or even minimal exposure to the practice (N60 min).…”

Increased Heart Rate Variability in Allergic and Highly Trait Anxious Individuals

“…Corresponding result was also found in our laboratory design study, using simulated public speech as stressful condition. Most studies associate high anxiety with reduced HRV and increased HR, which can also be seen in anxiety disorders studies [23]. On the other hand, close similarities between allergy and anxiety were documented [8,19,20].…”

“…This is even more apparent in anxiety disorders [23] and major depressive disorder [24,25]. Therefore, there are strong discrepancies between HRV findings in highly anxious and allergic people, although important links between both groups were described.…”