This Article Figures Only Full Text Full Text (PDF) View CVN Interview Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Shen, B.-J. Articles by Niaura, R. Search for Related Content PubMed Articles by Shen, B.-J. Articles by Niaura, R. Related Collections Related Article

CLINICAL RESEARCH: INFARCTION AND PSYCHOSOCIAL FACTORS

Anxiety Characteristics Independently and Prospectively Predict Myocardial Infarction in Men

The Unique Contribution of Anxiety Among Psychologic Factors

Biing-Jiun Shen, PhD^_*,_*, Yael E. Avivi, MS, John F. Todaro, PhD, Avron Spiro, III, PhD, Jean-Philippe Laurenceau, PhD^||, Kenneth D. Ward, PhD^# and Raymond Niaura, PhD^¶

^_* Department of Psychology, University of Southern California, Los Angeles, California
Department of Psychology, University of Miami, Coral Gables, Florida
Brown Medical School and Miriam Hospital, Providence, Rhode Island
Massachusetts Veterans Epidemiology Research and Information Center, Boston Veterans Administration Healthcare System, Boston, Massachusetts
^|| Department of Psychology, University of Delaware, Newark, Delaware
^# University of Memphis Center for Community Health, Memphis, Tennessee
^¶ Brown Medical School and Butler Hospital, Providence, Rhode Island.

Manuscript received February 5, 2007; revised manuscript received August 20, 2007, accepted September 7, 2007.

^_* Reprint requests and correspondence: Dr. Biing-Jiun Shen, Assistant Professor, Department of Psychology, University of Southern California, 3620 South McClintock Avenue, Los Angeles, California 90089-1061. (Email: bjshen{at}usc.edu).

Objectives: This study investigated whether anxiety characteristics independently predicted the onset of myocardial infarction (MI) over an average of 12.4 years and whether this relationship was independent of other psychologic variables and risk factors.

Background: Although several psychosocial factors have been associated with risk for MI, anxiety has not been examined extensively. Earlier studies also rarely addressed whether the association between a psychologic variable and MI was specific and independent of other psychosocial correlates.

Methods: Participants were 735 older men (mean age 60 years) without a history of coronary disease or diabetes at baseline from the Normative Aging Study. Anxiety characteristics were assessed with 4 scales (psychasthenia, social introversion, phobia, and manifest anxiety) and an overall anxiety factor derived from these scales.

Results: Anxiety characteristics independently and prospectively predicted MI incidence after controlling for age, education, marital status, fasting glucose, body mass index, high-density lipoprotein cholesterol, and systolic blood pressure in proportional hazards models. The adjusted relative risk (95% confidence interval [CI]) of MI associated with each standard deviation increase in anxiety variable was 1.37 (95% CI 1.12 to 1.68) for psychasthenia, 1.31 (95% CI 1.05 to 1.63) for social introversion, 1.36 (95% CI 1.10 to 1.68) for phobia, 1.42 (95% CI 1.14 to 1.76) for manifest anxiety, and 1.43 (95% CI 1.17 to 1.75) for overall anxiety. These relationships remained significant after further adjusting for health behaviors (drinking, smoking, and caloric intake), medications for hypertension, high cholesterol, and diabetes during follow-up and additional psychologic variables (depression, type A behavior, hostility, anger, and negative emotion).

Conclusions: Anxiety-prone dispositions appear to be a robust and independent risk factor of MI among older men.

Abbreviations and Acronyms   BMI = body mass index   CAD = coronary artery disease   HDL-C = high-density lipoprotein cholesterol   LDL-C = low-density lipoprotein cholesterol   MI = myocardial infarction   RR = relative risk   SBP = systolic blood pressure

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 51: A35-A36. [Full Text] [PDF]

This article has been cited by other articles:

				J. Denollet and S. S. Pedersen Anger, depression, and anxiety in cardiac patients: the complexity of individual differences in psychological risk. J. Am. Coll. Cardiol., March 17, 2009; 53(11): 947 - 949. [Full Text] [PDF]

				L. POZUELO, G. TESAR, J. ZHANG, M. PENN, K. FRANCO, and W. JIANG Depression and heart disease: What do we know, and where are we headed? Cleveland Clinic Journal of Medicine, January 1, 2009; 76(1): 59 - 70. [Abstract] [Full Text] [PDF]

				J. Denollet Depression, Anxiety, and Trait Negative Affect as Predictors of Cardiac Events: Ten Years After Psychosom Med, October 1, 2008; 70(8): 949 - 951. [Full Text] [PDF]