Meta-Analysis of Anxiety as a Risk Factor for Cardiovascular Disease

Abstract

Whether anxiety is a risk factor for a range of cardiovascular diseases is unclear. We aimed to determine the association between anxiety and a range of cardiovascular diseases. MEDLINE and EMBASE were searched for cohort studies that included participants with and without anxiety, including subjects with anxiety, worry, posttraumatic stress disorder, phobic anxiety, and panic disorder. We examined the association of anxiety with cardiovascular mortality, major cardiovascular events (defined as the composite of cardiovascular death, stroke, coronary heart disease, and heart failure), stroke, coronary heart disease, heart failure, and atrial fibrillation. We identified 46 cohort studies containing 2,017,276 participants and 222,253 subjects with anxiety. Anxiety was associated with a significantly elevated risk of cardiovascular mortality (relative risk [RR] 1.41, CI 1.13 to 1.76), coronary heart disease (RR 1.41, CI 1.23 to 1.61), stroke (RR 1.71, CI 1.18 to 2.50), and heart failure (RR 1.35, CI 1.11 to 1.64). Anxiety was not significantly associated with major cardiovascular events or atrial fibrillation although CIs were wide. Phobic anxiety was associated with a higher risk of coronary heart disease than other anxiety disorders, and posttraumatic stress disorder was associated with a higher risk of stroke. Results were broadly consistent in sensitivity analyses. Anxiety disorders are associated with an elevated risk of a range of different cardiovascular events, including stroke, coronary heart disease, heart failure, and cardiovascular death. Whether these associations are causal is unclear.

Symptom Burden of Atrial Fibrillation and Its Relation to Interventions and Outcome in Europe

“…The inverse association of anxiety with stroke is likely a spurious finding because of the comparatively small number of strokes. Prior cohort studies demonstrated an increased stroke risk in individuals with anxiety 20. In patients with AF, anxiety may be related to better compliance and medication adherence, however we could not demonstrate clear evidence to prove these assumption in our data.…”

The relationship between chronic physical conditions, multimorbidity and anxiety in the general population: A global perspective across 42 countries

“…For example, it is well established that anxiety is associated with several chronic physical co-morbidities [1]. Of particular concern are cardiovascular diseases [8], diabetes [9], pulmonary diseases [10], chronic pain [11], infectious diseases such as tuberculosis [12], arthritis [13], edentulism [14], and mainly in older people, visual impairment [15] and hearing problems [16]. Given the increasing prevalence of chronic conditions worldwide [17], a further understanding of the determinants, consequences and management of the comorbidity between anxiety and chronic physical conditions should be a research priority.…”

Anksioznost in koronarna bolezen srca

“…Približno 50 % bolnikov s koronarno boleznijo ima tudi depresivnost in anksioznost (8). Pri anksioznih bolnikih je tveganje za koronarno bolezen za 26 % višje, za 48 % višje pa je tveganje za srčno smrt (9,10). Bolniki s hudimi simptomi depresivnosti in anksioznostjo so imeli najvišjo prevalenco koronarne bolezni (11).…”