Anxiety and Risk of Incident Coronary Heart Disease
Open accessAbstract
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.
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Anxiety is associated with a 26% higher risk of cardiovascular disease and a 48% higher risk of cardiac mortality.
“a meta-analysis on the relationship between anxiety and cardiovascular outcomes that included the end points of cardiac death, myocardial infarction, and cardiac events demonstrated a 26% increased risk of having CVD and a 48% increased risk of cardiac mortality [6].”
From One-day acceptance and commitment therapy (ACT) workshop improves anxiety but not vascular function or inflammation in adults with moderate to high anxiety levels in a randomized controlled trial. (2021) · cites this paper as [6]
The Discussion reports a 26% increased risk of incident coronary heart disease (CHD) and a 48% increased risk of cardiac death among anxious people. The figures match the claim, but the source studied CHD in initially healthy individuals, not cardiovascular disease broadly. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPersons with a lifetime diagnosis of anxiety disorder have a 60% increased risk of cardiovascular disease onset.
“A meta-analysis showed that persons with a lifetime diagnosis of anxiety disorder have a 60% increased risk of cardiovascular disease onset 164 .”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [164]
The Discussion (p. 41) reports that anxiety was associated with a 26% increased risk of incident coronary heart disease, supporting the general association. It does not report a 60% increase in cardiovascular disease onset among people with a lifetime anxiety-disorder diagnosis; the included studies used varied anxiety measures, as shown in Table 1 (p. 41). (LLM, conf=0.90)
Experimental — accuracy not yet measuredTwo recent meta-analyses confirmed anxiety is an independent risk factor for incident CHD (HR 1.3) and for adverse events following myocardial infarction (OR 1.5 and 1.7).
“However, two recent meta-analyses confirmed that anxiety is an independent risk factor for incident CHD (HR 1.3) 111 and for adverse events following myocardial infarction (OR 1.5 and 1.7, respectively).112”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [111]
The association between poor social relationships and incident CVD is comparable in size to other recognised psychosocial risk factors, such as anxiety and job strain.
“We found an association between poor social relationships and incident CVD comparable in size to other recognised psychosocial risk factors, such as anxiety50 and job strain.51”
Anxiety disorders are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality.
“In addition to the profound negative impact on individuals’ wellbeing and functioning, they are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality.”
From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [13]
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References 54 · Cited by 865
Research works printed but not linked: 1
- [17]17. Stroup DF, Berlin JA, Morton SC et al., for the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group. Meta- analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000;283:2008 -12.
- Authors
- Roest, A. M., Martens, E. J., de Jonge, P., & Denollet, J.
- Affiliations
- Tilburg University (NL)
- Corresponding author
- Denollet, Johan
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 56
- Issue
- 1
- Pages
- 38-46
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2085437790
- Semantic Scholar
- 14f34066b854467164f7371fc72fed89bc4bb859
- Cited by
- 865
- References
- 54
- Citations by year
- 2026: 40 · 2025: 50 · 2024: 40 · 2023: 43 · 2022: 55 · 2021: 67 · 2020: 66 · 2019: 56 · 2018: 65 · 2017: 56 · 2016: 77 · 2015: 53 · 2014: 57 · 2013: 52 · 2012: 49
- FWCI
- 30.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Dutch Medical Research Council (016.086.397)
- Dutch Organization for Scientific Research (453.04.004)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- anxiety, coronary artery disease, incident coronary heart disease, cardiac mortality, myocardial infarction, cardiovascular risk factors, psychological stress
- MeSH terms
- Anxiety, Coronary Disease, Female, Follow-Up Studies, Humans, Male
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