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Meta-Analysis of Anxiety as a Risk Factor for Cardiovascular Disease

      Whether anxiety is a risk factor for a range of cardiovascular diseases is unclear. We aimed to determine the association between anxiety and a range of cardiovascular diseases. MEDLINE and EMBASE were searched for cohort studies that included participants with and without anxiety, including subjects with anxiety, worry, posttraumatic stress disorder, phobic anxiety, and panic disorder. We examined the association of anxiety with cardiovascular mortality, major cardiovascular events (defined as the composite of cardiovascular death, stroke, coronary heart disease, and heart failure), stroke, coronary heart disease, heart failure, and atrial fibrillation. We identified 46 cohort studies containing 2,017,276 participants and 222,253 subjects with anxiety. Anxiety was associated with a significantly elevated risk of cardiovascular mortality (relative risk [RR] 1.41, CI 1.13 to 1.76), coronary heart disease (RR 1.41, CI 1.23 to 1.61), stroke (RR 1.71, CI 1.18 to 2.50), and heart failure (RR 1.35, CI 1.11 to 1.64). Anxiety was not significantly associated with major cardiovascular events or atrial fibrillation although CIs were wide. Phobic anxiety was associated with a higher risk of coronary heart disease than other anxiety disorders, and posttraumatic stress disorder was associated with a higher risk of stroke. Results were broadly consistent in sensitivity analyses. Anxiety disorders are associated with an elevated risk of a range of different cardiovascular events, including stroke, coronary heart disease, heart failure, and cardiovascular death. Whether these associations are causal is unclear.
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      Linked Article

      • Anxiety and Incident Cardiovascular Disease: Is the Jury Still Out?
        American Journal of CardiologyVol. 120Issue 3
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          Anxiety disorders are prolific and burdensome globally.1 Anxiety is a troubling clinical presentation for the cardiologist because of high emergency department recidivism,2 unnecessary diagnostic work-ups, and follow-up appointments to rule out “organic” disease causes. The recent systematic review by Emdin et al3 included studies utilizing self-report to determine cardiovascular disease (CVD) status (e.g., in the past 3 years, have you been diagnosed or treated for heart disease, including heart attack, angina?), therefore reducing confidence in their findings.
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