Feb. 3, 2022 -- A new study shows that anxiety in midlife is associated with factors that increase risk for developing heart disease and diabetes in later life.

Among healthy middle-aged men who did not have heart disease or diabetes (cardiometabolic disease), those who had anxiety were more likely to have risk factors that are associated with higher cardiometabolic disease risk as they grew older.

The study led by Lewina Lee, PhD, was published in January in the Journal of the American Heart Association.

In this study, researchers used questionnaires that asked the men about two aspects of anxiety, namely neuroticism and excess worry.

Neuroticism is a tendency to perceive experiences as threatening, to feel that challenges are uncontrollable, and experience frequent and disproportionately intense negative emotions, such as fear, anxiety, sadness, and anger, across many situations, the researchers explain.

Worry, on the other hand, can be healthy and lead to constructive solutions, they note, but it also may be unhealthy, especially when it becomes uncontrollable and interferes with day-to-day functioning.

"Our finding suggest that anxiety is linked to unhealthy biological processes that pave the way to developing heart disease and diabetes in men," Lee, Assistant Professor of Psychiatry, Boston University School of Medicine, said.

People may not pay attention to their heart health until after they receive a diagnosis of heart disease, she noted.

That said, "our findings suggest that it is important to pay attention to indicators of cardiometabolic health, such as one's weight and blood pressure, at much younger ages," said Lee, as soon as your 30s or 40s.

"Doing so may have long-term benefits in preventing the development of heart disease and diabetes," she said.

Maintaining mental well-being is potentially one of the ways to preserve good cardiometabolic health, Lee said.

But since the study was done in men who were almost all White (97%) and veterans (94%), further research is needed to examine the impact of anxiety on heart health in women, nonveterans, people from different races, and younger people, she said.

"This study is another example of what we are finding more and more, namely that psychological health (such as depression or stress) can negatively impact heart health," said Glenn N. Levine, MD, who was not involved with this research.

"Everyone experiences some anxiety in their life," noted Levine, chief of cardiology, Michael E. DeBakey VA Medical Center in Houston, TX, who was writing group chair of a recent AHA Scientific Statement on Mind-Heart-Body connection.

However, people "who believe they are experiencing persistent, severe, and abnormal degrees of anxiety (or other factors such as depression or stress) might consider discussing this with their primary health providers, and consider meeting with a mental health professional," he said.

The researchers analyzed data from 1,561 men who were patients in the VA Boston outpatient clinic and enrolled in the Normative Aging Study.

When they enrolled in the study in 1975, the men were 33 to 84 years old (with an average age of 53) and they did not have heart disease, type 2 diabetes, stroke, or cancer.

At the start of the study, they replied to questionnaires about neuroticism and worry. They returned to the clinic for physical exams and blood tests every 3 to 5 years for the next 40 years (or until they died or dropped out of the study).

Of note, the term neurosis was no longer a separate diagnosis in diagnostic manuals from the American Psychiatric Association starting in 1980, and characteristics of neurosis are instead included as part of generalized anxiety disorder (GAD). GAD also includes excess worry.

The researchers found that men with high levels of neuroticism or worry at middle age were more likely to have a high cardiometabolic risk, defined as having at least 6 of the following:

  • systolic blood pressure > 130 mm Hg
  • diastolic blood pressure > 85 mm Hg
  • total cholesterol > 240 mg/dL
  • triglycerides > 150 mg/dL
  • body mass index > 30 kg/m2
  • glucose > 100 mg/dL
  • erythrocyte sedimentation rate (a marker of inflammation) > 14 mm/hour

Starting to take medication for any of these risks, except for high body mass index, was considered the same as having the high level of the risk marker.

As they grew older, men with anxiety in middle age were more likely to have at least 6 of these 7 cardiometabolic disease risk factors compared to the other men without anxiety in middle age.