Anxiety and Cardiovascular Risk: Review of Epidemiological and Clinical Evidence

Background

Coronary heart disease (CHD) is the leading cause of death and disability in the United States (US) and other developed countries 1. By the year 2020, CHD is projected to be the leading cause of death, not only in the developed world but also in the developing world 2–4. It is well known in the psychological literature that negative emotions such as anxiety are common among patients with cardiovascular (CV) symptoms, but few studies have examined associations between these two conditions.

ABSTRACT

An increasing body of evidence suggests that anxiety is an independent predictor of adverse cardiovascular (CV) events. Individuals with high levels of anxiety are at increased risk of coronary heart disease, congestive heart failure, stroke, fatal ventricular arrhythmias, and sudden cardiac death. Anxiety following a major cardiac event can impede recovery, and is associated with a higher morbidity and mortality. This linkage between anxiety and CV disease is further corroborated by evidence suggesting that treatment of anxiety may improve cardiac symptoms. However, the mechanisms underlying the observed associations are not entirely delineated. Several intermediary mechanisms have been suggested, including sympathetic activation, impaired vagal control, reduced heart rate variability, stimulation of the hypothalamic–pituitary axis, hyperventilation-induced coronary spasm, oxidative stress, increased inflammatory mediators, and unhealthy lifestyle. There is a need for several clinical trials to explicate the complex associations between anxiety and CV disease, which may be compounded by the involvement of other psychosocial factors. In this review, we examine the epidemiological evidence for the association between anxiety and CV disease, and discuss the proposed mechanisms that may be responsible for this association.

Keywords

cardiovascular risk, anxiety, psychological distress, emotion