Anxiety a predictor for cardiac death

ANXIETY can be confirmed as an independent risk factor for coronary heart disease (CHD) and cardiac mortality, Australian experts say, after a meta-analysis found it was strongly associated with these outcomes.

The review of 20 prospective studies, including 249,846 ‘healthy’ persons, found those with anxiety disorders had a 26% higher risk of CHD and a 48% higher risk of cardiac mortality.

The results were independent of demographic variables, biological risk factors and health behaviours.

The findings were further bolstered by a Swedish study of 49,321 men followed for 37 years, which found those with anxiety at baseline had double the risk of CHD or MI after 37 years.

The authors speculated over the mechanism. “Sympathetic over-activity and autonomic dysfunction might explain the increased risk of cardiac events among participants diagnosed with anxiety,” they said.

Professor Andrew Tonkin, head of the Cardiovascular Research Unit at Monash University, said the increased risk for coronary heart disease due to anxiety could “not be ignored”.

David Clarke, professor of psychiatry at Monash University, agreed, saying the findings backed previous evidence.

“It looks to me like the risk for heart disease is not quite as strong as depression, but it’s still very significant.”

First-line treatment would include behavioural strategies to reduce stress levels, followed by treatment with benzodiazepines or SSRIs, he said. 

J Am Coll Cardiol 2010; 56:31-46