Longterm anxiety 'ups' the risk for heart attacks

May 15 2007

According to researchers in the United States, for patients with coronary artery disease, anxiety increases their risk of heart attacks and death.

The new research shows that highly anxious patients with heart disease face nearly double the risk of heart attack or death when compared to those with a more serene outlook on life; and those whose anxiety intensified over time were at greatest risk, while those who started out highly anxious but later found inner calm markedly reduced their risk.

Experts say that coronary artery disease is caused by plaque build-up on the inside walls of the arteries that supply blood and oxygen to the heart, which makes them harden and narrow leading to heart attacks, angina and other serious complications.

There is ample research on the toll that mental stress has on cardiac health, but this as a rule has focused on depression rather than anxiety.

In a study involving 516 patients with heart disease by researchers at Harvard Medical School in Boston, it was found that high anxiety score over a period of time was associated with an elevated risk of both heart attack and death from any cause.

Dr. Charles M. Blatt and colleagues asked the patients to complete a standard anxiety questionnaire annually for an average of just over 3 years; the study group was made up of mainly men (82 percent) with an average age of 68 years.

During the study period, the researchers say a total of 44 nonfatal heart attacks and 19 deaths occurred and a high cumulative anxiety score was associated with an elevated risk of both heart attack and death from any cause, whereas the initial anxiety score was not.

Dr. Blatt says those with average anxiety scores in the highest 25 percent were nearly twice as likely to die of a heart attack or death from any cause compared with those with scores in the lowest 25 percent.

When they carried out a further analysis of the data, the researchers factored in the effects of high blood pressure, diabetes, and other known cardiovascular risk factors, each unit increase in the overall anxiety score increased the odds of nonfatal heart attack or death by 6 percent.

The researchers say initial anxiety scores failed to predict negative patient outcomes, and assessing anxiety regularly over the long-term is necessary.

They suggest randomly assigned clinical studies are now in order to discover if treatment to reduce anxiety with anti-anxiety medications and psychotherapy will improve the outcome of patients with coronary artery disease.

Dr. Blatt, a clinical professor of medicine says most patients are initially very anxious about their coronary condition and it is important for doctors to reassure anxious patients.

He believes time spent by doctors with the patient and the family and interacting with them is critically important to clinical outcomes.

The study is published in the Journal of the American College of Cardiology, May 22, 2007.