The first study, by Annelieke M. Roest, MSc, of Tilburg University in the Netherlands, combined data from 20 studies on nearly 250,000 people. The average follow-up period was 11 years.
The researchers found that anxiety was associated with a 26% increased risk of coronary heart disease and a 48% increased risk of heart-related death over the follow-up period, even after adjusting for known heart disease risk factors.
The second study, by Imre Janszky, MD, PhD, of Karolinska Institutet in Stockholm, Sweden, also found that anxiety disorders are predictive of future heart disease even after controlling for other risk factors such as blood pressure and smoking.
Anxiety more than doubled the subsequent risk of developing coronary blockages or having a heart attack. They examined data on 50,000 young Swedish men evaluated for military service between ages 18 and 20, with a follow-up of about 37 years.
The studies and an accompanying editorial by Joel Dimsdale, MD, professor of psychiatry at the University of California-San Diego, are now online and scheduled for publication in the June 29 issue of the Journal of the American College of Cardiology.
Emotional Health of Patients
Dimsdale writes that the findings of the studies reinforce the need for doctors to assess the emotional health of patients in addition to asking them about physical symptoms. This is important, he says, because nearly three in 10 people will suffer anxiety symptoms at some point in their lives.
Dimsdale notes that the studies did not address the question of treatment strategies or whether finding ways to alleviate anxiety, through medications, psychotherapy, stress reduction or lifestyle changes, would do any good.
"Is our fate sealed as soon as we have an early-life anxiety disorder?" he asks rhetorically. The answer, he tells WebMD, is no, and says clinicians should assume that treatment of anxiety disorders might have long-term benefits.
"Physicians are frequently timid about assessing emotional symptoms," he writes in the editorial. "It is odd that we thread catheters, ablate lesions and give rectal exams but are uncomfortable asking our patients about their lives."
Asking patients questions about their emotional problems might be relevant for diagnosis and prevention of cardiovascular disease, Dimsdale says.
Dimsdale tells WebMD that the studies "point to risks, not certainties," and that just because people may have anxiety disorders "this does not at all mean that your fate is sealed."
He says people can deal with anxiety in different ways.
"For many people, frequent aerobic exercise is a major boon, not just for anxiety but also because of its beneficial effects on coronary circulation," he tells WebMD. And even smokers with anxiety disorders can improve their odds of avoiding heart disease by kicking the habit, he says.
"That emotional factors affect the heart is obvious. How they do so and how to mitigate these effects remains to be discovered," writes Dimsdale. He encourages cardiologists and others to use tools such as one called Prime-MD, which include easy-to-ask questions about anxiety.