Phobias May Put Women's Hearts at Risk

Feb. 1, 2005 -- Women who suffer from anxiety disorders may be more likely to die of heart disease than other women without such fears and anxieties, according to a new study.

Researchers found that women with high levels of anxiety from phobias and other persistent sources of anxiety had a 59% higher risk of sudden cardiac death, and a 31% higher risk of suffering another type of heart-related death.

Those risks were lower after taking other risk factors commonly found in people with phobic anxiety into account, such as high blood pressure, diabetes, and high cholesterol. But researchers say even after controlling for these heart disease risk factors, women with phobias tended to have a higher risk of sudden cardiac death.

Sudden cardiac death is the most common cause of natural death in the U.S., accounting for almost 250,000 adult deaths each year. The condition is usually triggered by a disruption of heart rhythm that results in a sudden, unexpected loss of heart function.

Fear May Affect Women's Hearts

Previous studies in men have shown that psychological factors, such as emotions, anxiety, and anger can raise the risk of heart disease and death. In particular, these studies have also shown that phobic anxiety, or anxiety caused by a deep-seated fear, is related to the risk of sudden cardiac death.

"Since these studies have been done in men, we decided that we would look to see if there was a similar relationship in women," says researcher Christine M. Albert, MD, MPH, assistant professor at Harvard Medical School, Boston, in a news release.

In the study, which appears in the Feb. 1 issue of Circulation: Journal of the American Heart Association, researchers looked at the relationship between phobic anxiety and heart disease among women who participated in the Nurses' Health Study.

Researchers measured levels of phobic anxiety among the women based on their answers to the Crown-Crisp index, which ranks the degree of phobic anxiety on a scale of one to 16 with higher scores indicating more anxiety.

Sample questions used in the test included:

• Do you have an unreasonable fear of being in enclosed spaces such as shops or elevators?
• Do you find yourself worrying about getting some incurable illness?
• Are you scared of heights?
• Do you feel panicky in crowds?
• Do you worry unduly when relatives are late in coming home?
• Do you feel more relaxed indoors?
• Do you dislike going out alone?
• Do you feel uneasy traveling on buses or trains even if they are not crowded?

Among the more than 72,000 women who took part in the study, 97 sudden cardiac deaths, 267 deaths due to heart disease, and 930 nonfatal heart attacks were reported over 12 years of follow- up. None of the participants had a prior history of heart disease.

"We found that women who suffered most from phobic anxiety -- those who scored four or greater on the survey -- were at a marginally increased risk of dying suddenly from coronary heart disease in general compared to those in the lowest quarter of the population," says Albert.

Albert says much of this increased risk was explained by the fact that women who had high levels of anxiety were also more likely to smoke, have high blood pressure, diabetes, and high cholesterol.

"It is not known whether phobic anxiety makes women more likely to develop other risk factors for heart disease or whether these risk factors lead to higher levels of phobic anxiety," says Albert.