Can anxiety increase my risk for heart disease?

A new Dutch Study, led by Elisabeth J. Martens of Tilburg University in the Netherlands, found that anxiety disorders may increase the risk of heart attack, stroke, heart failure and death in people with heart disease. The research included over 1,000 people with stable coronary heart disease (CHD) who were assessed for anxiety disorder at the start of the study and then followed for an average of 5.6 years.

During that time, there were a total of 371 cardiovascular events (heart attacks or other incidents that may cause damage to the heart). The yearly rate of cardiovascular events was 9.6% among the 106 patients with generalized anxiety disorder (GAD) and 6.6% among the other 909 patients. After adjusting for a number of factors -- such as other health problems, heart disease severity and medication use -- the researchers concluded that generalized anxiety disorder was associated with a 74% increased risk of cardiovascular events.

According to Dr. Martens and colleagues, many factors may account for the increase in risk:

• Anxiety may be linked with surges in "fight or flight" hormones called catecholamines that may be related to heart risks;
• Anxious patients with CHD may be less likely to seek preventive medical care due to an "avoidant coping strategy";
• People with anxiety may be more likely to seek medical care when they have symptoms of a cardiovascular event (although researchers noted this wouldn't explain the higher rates of death);
• It's also possible that a common underlying factor may increase the risk of both anxiety and heart events.

Between 24% and 31% of people with heart disease have symptoms of anxiety, according to various studies. But these findings are somewhat questionable, as some of the research relied on participants' recollections or single objective "snapshot" assessments rather than using structured interviews to diagnose anxiety. Many studies have also lacked controls for factors such as lifestyle that could affect heart disease risk.

However, two studies that followed large numbers of participants over time addressed some of those weaknesses, such as controlling for confounding factors such as major depression (which often occurs in conjunction with anxiety). The results showed that generalized anxiety disorder -- characterized by constant and pervasive anxiety, even about mundane matters -- appears to increase the risk of heart attacks.