Autonomic Neural Circuit and Intervention for Comorbidity Anxiety and Cardiovascular Disease

Abstract

Anxiety disorder is a prevalent psychiatric disease and imposes a significant influence on cardiovascular disease (CVD). Numerous evidence support that anxiety contributes to the onset and progression of various CVDs through different physiological and behavioral mechanisms. However, the exact role of nuclei and the association between the neural circuit and anxiety disorder in CVD remains unknown. Several anxiety-related nuclei, including that of the amygdala, hippocampus, bed nucleus of stria terminalis, and medial prefrontal cortex, along with the relevant neural circuit are crucial in CVD. A strong connection between these nuclei and the autonomic nervous system has been proven. Therefore, anxiety may influence CVD through these autonomic neural circuits consisting of anxiety-related nuclei and the autonomic nervous system. Neuromodulation, which can offer targeted intervention on these nuclei, may promote the development of treatment for comorbidities of CVD and anxiety disorders. The present review focuses on the association between anxiety-relevant nuclei and CVD, as well as discusses several non-invasive neuromodulations which may treat anxiety and CVD.

Prevalence and predictors of preoperative cardiac autonomic dysfunction among elective neurosurgical patients: A prospective observational study

“…[ 22 ] Most earlier studies noted a positive association between DM and hypertension with CAD. [ 23 24 ] However, this association was not reflected in our study, which agrees with the findings of Polderman et al . [ 12 ] This may be due to the low prevalence of DM, hypertension, and IHD in our study.…”

Anxiety disorder and cardiovascular disease: a two‐sample Mendelian randomization study

“…Consequently, anxiety disorders may instigate chronic inflammation, which has the potential to harm the endothelial lining of blood vessels, a factor associated with heart attacks or strokes 24,25 . The impact of anxiety on the cardiovascular system involves a complex autonomic circuit, comprising anxiety‐related nuclei and the autonomic nervous system 26 . Anxiety disorders may induce psychological stress, triggering the activation of the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis, resulting in elevated levels of catecholamines, cortisol, and other hormones that can destabilize atherosclerotic plaques, ultimately leading to thrombosis, a primary cause of acute coronary syndromes 27–29 .…”

“… 24 , 25 The impact of anxiety on the cardiovascular system involves a complex autonomic circuit, comprising anxiety‐related nuclei and the autonomic nervous system. 26 Anxiety disorders may induce psychological stress, triggering the activation of the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis, resulting in elevated levels of catecholamines, cortisol, and other hormones that can destabilize atherosclerotic plaques, ultimately leading to thrombosis, a primary cause of acute coronary syndromes. 27 , 28 , 29 Furthermore, anxiety disorders may elevate the risk of cardiac dysfunction and adverse outcomes by potentially impeding the cardioprotective effects of vagus‐mediated B‐type natriuretic peptide (BNP).…”

Risk factors for depresion and anxiety in the patient with aortic valve stenosis

“…Finally, the presence of anxiety will be subject to changes in duration, severity, persistence, degree of distress and cognitive impairment in what could develop into an anxiety disorder; currently prevalent throughout the lives from 10 to 20% sharing comorbidities with mood disorders and substance abuse. 24,25…”