Dutch researchers have determined that heart patients with anxiety disorders may have an increased risk for stroke, heart attack, heart failure and death.
The study evaluated 1,015 stable heart disease patients, an average of 6 years. During that time 371 clinically significant cardiovascular events occurred.
As many as 24 percent to 31 percent of patients with heart disease also have symptoms of anxiety. The study’s researchers decided to evaluate anxiety because while extensive research on depression and heart disease exists, only a few studies have examined the role of anxiety." The authors wrote, "Several studies have found that anxiety symptoms are predictive of disability, increased physical symptoms and worse functional status and quality of life in patients with coronary heart disease. However, studies examining anxiety as a risk factor for future coronary heart disease have yielded conflicting results."
Elisabeth Martens of Tilburg University and colleagues published the study in the Archives of General Psychiatry, found that after adjusting for age, the yearly rate of cardiovascular events including heart attack, stroke, heart failure and death, was almost 10 (9.6) per cent in the 106 participants experiencing general anxiety disorder. While the 909 participants without an anxiety disorder had 1/3 fewer 6.6 per cent.
After adjusting for other significant factors, including sex, heart disease severity and medications, generalized anxiety disorder was associated with a 74 per cent increased risk of cardiovascular events.
Anxiety triggers changes in the body, that stimulate the release of stress related hormones, those involved in the ‘fight or flight’ response, that may be related to heart disease risk.
"This leaves the question of why generalized anxiety disorder is associated with adverse outcomes in patients with coronary heart disease," the authors wrote. Anxiety may be associated with surges in catecholamines, "fight or flight" hormones that may be related to heart risks, they suggest. Alternatively, patients with anxiety may be more likely to seek care when they have symptoms and therefore be more likely to receive a diagnosis of stroke or heart attack, although this would not explain the increased risk of death. It is also possible that a common underlying factor predisposes individuals to both anxiety and heart events.
"These findings have implications for clinical practice and research," they concluded. "Generalized anxiety disorder may be considered a prognostic factor in patients with coronary heart disease and could be used in risk stratification. Evaluation and treatment of anxiety may also be considered as part of the comprehensive management of patients with coronary heart disease.”