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QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: CLINICAL RESEARCH: CARDIOVASCULAR RISK

Anxiety and Risk of Incident Coronary Heart Disease

A Meta-Analysis

Annelieke M. Roest, MSc^_*, Elisabeth J. Martens, PhD^_*, Peter de Jonge, PhD^_*, and Johan Denollet, PhD^_*,_*

^_* Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
Department of Psychiatry, University of Groningen, Groningen, the Netherlands

Manuscript received November 4, 2009; revised manuscript received January 28, 2010, accepted March 3, 2010.

^_* Reprint requests and correspondence: Dr. Johan Denollet, CoRPS, Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands (Email: j.denollet{at}uvt.nl).

Objectives: The purpose of this study was to assess the association between anxiety and risk of coronary heart disease (CHD).

Background: Less research has focused on the association of anxiety with incident CHD in contrast to other negative emotions, such as depression.

Methods: A meta-analysis of references derived from PubMed, EMBASE, and PsycINFO (1980 to May 2009) was performed without language restrictions. End points were cardiac death, myocardial infarction (MI), and cardiac events. The authors selected prospective studies of (nonpsychiatric) cohorts of initially healthy persons in which anxiety was assessed at baseline.

Results: Twenty studies reporting on incident CHD comprised 249,846 persons with a mean follow-up period of 11.2 years. Anxious persons were at risk of CHD (hazard ratio [HR] random: 1.26; 95% confidence interval [CI]: 1.15 to 1.38; p < 0.0001) and cardiac death (HR: 1.48; 95% CI: 1.14 to 1.92; p = 0.003), independent of demographic variables, biological risk factors, and health behaviors. There was a nonsignificant trend for an association between anxiety and nonfatal MI (HR: 1.43; 95% CI: 0.85 to 2.40; p = 0.180). Subgroup analyses did not show any significant differences regarding study characteristics, with significant associations for different types of anxiety, short- and long-term follow-up, and both men and women.

Conclusions: Anxiety seemed to be an independent risk factor for incident CHD and cardiac mortality. Future research should examine the association between anxiety and CHD with valid and reliable anxiety measures and focus on the mechanisms through which anxiety might affect CHD.

Key Words: anxiety • cardiac mortality • coronary heart disease • meta-analysis • myocardial infarction • risk

Abbreviations and Acronyms   CHD = coronary heart disease   CI = confidence interval   HR = hazard ratio   MI = myocardial infarction

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