Association of anxiety with resistance vessel dysfunction in human atherosclerosis
Open accessAbstract
OBJECTIVE: Anxiety predicts cardiovascular events, although the mechanism remains unclear. We hypothesized that anxiety symptoms will correlate with impaired resistance and conduit vessel function in participants aged 55 to 90 years. METHODS: Anxiety symptoms were measured with the Symptom Checklist-90--Revised in 89 participants with clinically diagnosed atherosclerotic cardiovascular disease and 54 healthy control participants. Vascular function in conduit arteries was measured using flow-mediated dilatation, and vascular function in forearm resistance vessels (FRVs) was measured using intra-arterial drug administration and plethysmography. RESULTS: Anxiety symptoms were not associated with flow-mediated dilatation in either group. Participants with atherosclerosis exhibited significant inverse associations of anxiety symptoms with FRV dilatation (acetylcholine: β = -.302, p = .004). Adjustment for medication, risk factors, and depression symptoms did not alter the association between anxiety and FRV dysfunction, except for body mass index (BMI; anxiety: β = -.175, p = .060; BMI: β = -.494, p < .001). Although BMI was more strongly associated with FRV function than anxiety, combined BMI and anxiety accounted for greater variance in FRV function than either separately. Control participants showed no association of anxiety with FRV function. CONCLUSIONS: Anxiety is uniquely and substantially related to poorer resistance vessel function (both endothelial and vascular smooth muscle functions) in individuals with atherosclerosis. These relationships are independent of medication, depression, and cardiovascular risk factors, with the exception of BMI. These findings support the concept that anxiety potentially increases vascular events through worsening of vascular function in atherosclerotic disease.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In adults with atherosclerosis, anxiety is independently associated with lower forearm resistance microvascular function after adjustment for cardiovascular disease risk factors.
“Stillman et al. (2013) found a significant independent association between anxiety and decreased forearm resistance microvascular function after controlling for CVD risk factors in adults with atherosclerosis [11].”
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 [11]
The Discussion reports that anxiety was associated with impaired forearm resistance vessel function in participants with atherosclerosis, independently of most conventional risk factors. But the Results show that, in a model including BMI and other significant covariates, anxiety only trended toward significance (p=0.054); the claim omits this exception to its assertion of a significant independent association after risk-factor adjustment. No page numbers are available in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredAnxiety is not associated with peripheral conduit artery endothelial function measured by brachial artery flow-mediated dilation, suggesting that endothelial dysfunction in anxiety is selective to the resistance artery microcirculation.
“In contrast, there was no association between anxiety and peripheral conduit artery endothelial function as assessed by brachial artery flow-mediated dilation (FMD), suggesting that vascular endothelial dysfunction in individuals with anxiety is selective to the resistance artery microcirculation rather than larger conduit muscular arteries.”
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 [11]
The Results and the Discussion’s ‘Resistance versus conduit vessels’ section report no association between anxious symptoms and brachial FMD, alongside an association with resistance-vessel dysfunction in participants with atherosclerosis. The claim extends that pattern to individuals with anxiety generally, although the reported resistance-vessel finding is specific to participants with atherosclerosis. The study also reports vascular smooth muscle dysfunction, not only endothelial dysfunction. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStillman et al. (2013) demonstrated that forearm resistance artery function was associated with anxiety in older adults with atherosclerosis, but there was no relation with peripheral conduit artery endothelial function as assessed by brachial artery FMD.
“Stillman et al. (2013) demonstrated that forearm resistance artery function, as assessed by in response to intra-brachial artery infusions of endothelial-dependent and –independent pharmacological agonists, was associated with anxiety in a cohort of older adults with a history of atherosclerosis. In contrast, there was no relation with peripheral conduit artery endothelial function as assessed by”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Hubert, H. B., Feinleib, M., McNamara, P. M., & Castelli, W. P. (1983) · Circulation · doi:10.1161/01.cir.67.5.968 · Cited by 4,241 · see citing works
Anxiety and Risk of Incident Coronary Heart Disease
Roest, A. M., Martens, E. J., de Jonge, P., & Denollet, J. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.03.034 · Cited by 865 · see citing works
Depression, anxiety and somatization in primary care: Syndrome overlap and functional impairment
Löwe, B., Spitzer, R. L., Williams, J. B. W., Mussell, M., Schellberg, D., & Kroenke, K. (2008) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2008.01.001 · Cited by 706 · see citing works
Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study.
Kawachi, I. I., Sparrow, D., Vokonas, P., & Weiss, S. T. (1994) · Circulation · doi:10.1161/01.cir.90.5.2225 · Cited by 618 · see citing works
Jonas, B. S. (1997) · Archives of Family Medicine · doi:10.1001/archfami.6.1.43 · Cited by 511 · see citing works
Rates of dementia in three ethnoracial groups
Gurland, B. J., Wilder, D. E., Lantigua, R., Stern, Y., Chen, J., Killeffer, E. H. P., & Mayeux, R. P. (1999) · International Journal of Geriatric Psychiatry · doi:10.1002/(sici)1099-1166(199906)14:6 · Cited by 417 · see citing works
Further evidence for the validity of the beck anxiety inventory with psychiatric outpatients
Steer, R. A., Ranieri, W. F., Beck, A. T., & Clark, D. A. (1993) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(93)90002-3 · Cited by 318 · see citing works
Yeragani, V. K., Pohl, R., Berger, R. D., Balon, R., Ramesh, C., Glitz, D. A., Srinivasan, K., & Weinberg, P. (1993) · Psychiatry Research · doi:10.1016/0165-1781(93)90011-5 · Cited by 285 · see citing works
Haynes, W. G., Strachan, F. E., & Webb, D. J. (1995) · Circulation · doi:10.1161/01.cir.92.3.357 · Cited by 279 · see citing works
Self-citationSchmitz, N., Kruse, J., Heckrath, C., Alberti, L., & Tress, W. (1999) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270050156 · Cited by 276 · see citing works
Early-Onset Depression, Anxiety, and Risk of Subsequent Coronary Heart Disease
Janszky, I., Ahnve, S., Lundberg, I., & Hemmingsson, T. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.03.033 · Cited by 260 · see citing works
Xanthine Oxidase Inhibition Reverses Endothelial Dysfunction in Heavy Smokers
Guthikonda, S., Sinkey, C., Barenz, T., & Haynes, W. G. (2003) · Circulation · doi:10.1161/01.cir.0000046448.26751.58 · Cited by 225 · see citing works
Self-citationEndothelial Function in Resistance and Conduit Arteries and 5-Year Risk of Cardiovascular Disease
Lind, L., Berglund, L., Larsson, A. O., & Sundström, J. (2011) · Circulation · doi:10.1161/circulationaha.110.984047 · Cited by 216 · see citing works
Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System
Li, C., Barker, L., Ford, E. S., Zhang, X., Strine, T. W., & Mokdad, A. H. (2008) · Diabetic Medicine · doi:10.1111/j.1464-5491.2008.02477.x · Cited by 175 · see citing works
Smoking behaviors across anxiety disorders
McCabe, R. E., Chudzik, S., Antony, M. M., Young, L., Swinson, R. P., & Zolvensky, M. J. (2003) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2003.07.003 · Cited by 164 · see citing works
Mental disorders in patients with obesity in comparison with healthy probands
Baumeister, H., & Härter, M. C. (2007) · International Journal of Obesity · doi:10.1038/sj.ijo.0803556 · Cited by 155 · see citing works
Lambert, É., Dawood, T., Straznicky, N. E., Sari, C. I., Schlaich, M. P., Esler, M., & Lambert, G. W. (2010) · Journal of Hypertension · doi:10.1097/hjh.0b013e3283350ea4 · Cited by 120 · see citing works
Lind, L., Sarabi, & Millgård (1998) · Clinical Physiology · doi:10.1046/j.1365-2281.1998.00077.x · Cited by 110 · see citing works
Validity of the GHQ and SCL anxiety and depression scales: A comparative study
Koeter, M. W. J. (1992) · Journal of Affective Disorders · doi:10.1016/0165-0327(92)90112-j · Cited by 106 · see citing works
Narita, K., Murata, T., Hamada, T., Takahashi, T., Omori, M., Suganuma, N., Yoshida, H., & Wada, Y. (2007) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2006.01.003 · Cited by 100 · see citing works
Evaluation of endothelium‐dependent vasodilation in the human peripheral circulation
Lind, L., Hall, J., Larsson, A., Annuk, M., Fellström, B., & Lithell, H. (2000) · Clinical Physiology · doi:10.1046/j.1365-2281.2000.00281.x · Cited by 99 · see citing works
Fiedorowicz, J. G., He, J., & Merikangas, K. R. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.07.010 · Cited by 98 · see citing works
Self-citationAssociations Between Psychological Traits and Endothelial Function in Postmenopausal Women
Harris, K. F., Matthews, K. A., Sutton-Tyrrell, K., & Kuller, L. H. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000035720.08842.9f · Cited by 94 · see citing works
Factor Structure and Discriminant Validity of the SCL-90 in a Veteran Psychiatric Population
Clark, A., & Friedman, M. J. (1983) · Journal of Personality Assessment · doi:10.1207/s15327752jpa4704_10 · Cited by 89 · see citing works
Psychotic symptoms in the elderly: a prospective study in a population sample
Henderson, A. S., Korten, A. E., Levings, C. T., Jorm, A. F., Christensen, H. M., Jacomb, P. A., & Rodgers, B. (1998) · International Journal of Geriatric Psychiatry · doi:10.1002/(sici)1099-1166(199807)13:7 · Cited by 85 · see citing works
Prevalence and correlates of anxiety among nursing home patients
Smalbrugge, M., Pot, A. M., Jongenelis, K., Beekman, A. T. F., & Eefsting, J. A. (2005) · Journal of Affective Disorders · doi:10.1016/j.jad.2005.06.006 · Cited by 78 · see citing works
Adverse Impact of Mood on Flow-Mediated Dilation
Cooper, D. C., Milic, M. S., Tafur, J., Mills, P. J., Bardwell, W. A., Ziegler, M. G., & Dimsdale, J. E. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181cdbfc0 · Cited by 76 · see citing works
Witte, D. R., van der Graaf, Y., Grobbee, D. E., & Bots, M. L. (2005) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2005.02.012 · Cited by 58 · see citing works
Influence of exercise on anxiety level in patients with anxiety disorders
Cameron, O. G., & Hudson, C. J. (1986) · Psychosomatics · doi:10.1016/s0033-3182(86)72622-4 · Cited by 46 · see citing works
Narita, K., Murata, T., Hamada, T., Kosaka, H., Sudo, S., Mizukami, K., Yoshida, H., & Wada, Y. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.11.013 · Cited by 38 · see citing works
Symptom Dimensions of the SCL-90-R: A Test of the Tripartite Model of Anxiety and Depression
Steer, R. A., Clark, D. A., & Ranieri, W. F. (1994) · Journal of Personality Assessment · doi:10.1207/s15327752jpa6203_12 · Cited by 38 · see citing works
What Is the Most Appropriate Methodology for Detection of Conduit Artery Endothelial Dysfunction?
Guthikonda, S., Sinkey, C. A., & Haynes, W. G. (2007) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.106.131011 · Cited by 33 · see citing works
Self-citationNarita, K., Murata, T., Hamada, T., Takahashi, T., Kosaka, H., Yoshida, H., & Wada, Y. (2006) · International Psychogeriatrics · doi:10.1017/s1041610206004571 · Cited by 32 · see citing works
Moser, D. J., Robinson, R. G., Hynes, S. M., Reese, R. L., Arndt, S. V., Paulsen, J. S., & Haynes, W. G. (2006) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.0000250973.93401.2d · Cited by 27 · see citing works
Self-citationLind, L. (2006) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2006.01.023 · Cited by 25 · see citing works
Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam
Beekman (1998) · Pure Amsterdam UMC · doi:10.1002/(sici)1099-1166(1998100)13:10 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Chrysohoou, C. A., Kollia, N., & Tousoulis, D. (2017) · Maturitas · doi:10.1016/j.maturitas.2017.12.001 · Cited by 90 · see citing works
Anxiety and prognosis of patients with myocardial infarction: A meta‐analysis
Wen, Y., Yang, Y., Shen, J., & Luo, S.-X. (2021) · Clinical Cardiology · doi:10.1002/clc.23605 · Cited by 49 · see citing works
Panic disorder and cardiovascular diseases: an overview
Machado, S. E. D. C., Sancassiani, F., Paes, F., Rocha, N., Murillo‐Rodríguez, E., & Nardi, A. E. (2017) · International Review of Psychiatry · doi:10.1080/09540261.2017.1357540 · Cited by 33 · see citing works
Musey, P. I., Schultebraucks, K., & Chang, B. (2019) · Academic Emergency Medicine · doi:10.1111/acem.13882 · Cited by 31 · see citing works
da Silva, C. T. B., Schuch, F. B., Costa, M. D. A., Hirakata, V. N., & Manfro, G. G. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.007 · Cited by 26 · see citing works
Cogan, B., Pearson, R. C., Paton, C. M., Jenkins, N. T., & Cooper, J. A. (2023) · Nutrition Research · doi:10.1016/j.nutres.2023.01.001 · Cited by 19 · see citing works
Resende, M. M. D. C., Costa, F. E. D. C., Gardona, R. G. B., Araújo, R. G., Mundim, F. G. L., & Costa, M. J. D. C. (2014) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2014.06.008 · Cited by 17 · see citing works
Impact of Mood on Endothelial Function and Arterial Stiffness in Bipolar Disorder
Schmitz, S. L., Abosi, O. J., Persons, J. E., Sinkey, C. A., & Fiedorowicz, J. G. (2018) · Heart and Mind · doi:10.4103/hm.hm_20_19 · Cited by 17 · see citing works
Self-citationLászló, A., Babos, L., Kis-Igari, Z., Pálfy, A., Torzsa, P., Eőry, A., Kalabay, L., Gonda, X., Rihmer, Z., Cseprekál, O., et al. (2015) · Annals of General Psychiatry · doi:10.1186/s12991-015-0072-0 · Cited by 15 · see citing works
Sriboonlert, J., Munkong, W., Rintawut, S., Paladkhua, S., Suwongsa, R., & Kirisattayakul, W. (2023) · Journal of Evidence-Based Integrative Medicine · doi:10.1177/2515690x221150527 · Cited by 12 · see citing works
Clinical phenotypes of comorbidities in end-stage knee osteoarthritis: a cluster analysis
Ma, J., Zhang, K., Ma, X., Wang, H., Ma, C., Zhang, Y., & Liu, R. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-07394-1 · Cited by 12 · see citing works
Cardiovascular disease and depression: a bidirectional relationship and its clinical implications
Wu, J., Tian, Z., Qi, Z., Liu, X., & Yu, P. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1675680 · Cited by 13 · see citing works
Corones‐Watkins, K., Theobald, K. A., & White, K. M. (2018) · Australian Critical Care · doi:10.1016/j.aucc.2018.06.009 · Cited by 11 · see citing works
Clausen, A. N., Aupperle, R. L., Sisante, J.-F. V., Wilson, D. R., & Billinger, S. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0162547 · Cited by 10 · see citing works
da Silva, C. T. B., da Silva, A. M. V., Costa, M. D. A., SANT'ANNA, R. T., Heldt, E., & Manfro, G. G. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.10.170 · Cited by 9 · see citing works
Fiedorowicz, J. G., Dindo, L., Ajibewa, T., Persons, J., Marchman, J., Holwerda, S. W., Abosi, O. J., DuBose, L. E., Wooldridge, N., Myers, J., et al. (2021) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2021.09.009 · Cited by 7 · see citing works
Self-citationLee, C., Lee, S. C., Shin, Y. S., Park, S., Won, K. B., Ann, S. H., & Ko, E. J. (2020) · Healthcare · doi:10.3390/healthcare8040568 · Cited by 8 · see citing works
Platelets-released insulin-like growth factor 1 is correlated with anxiety in myocardial infarction
Liu, Z., Wang, Y., Pan, S., Zhang, Y., Zhu, H., Liu, Y., Zhu, L., & Zhang, J. (2019) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2019.10.042 · Cited by 8 · see citing works
A Narrative Review of the Relationship Between Coronary Heart Disease and Anxiety
Dahale, A. B., Menon, J. C., & Jaisoorya, T. S. (2017) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.7722 · Cited by 6 · see citing works
Complementary Therapies for the Body, Mind and Soul
Saad, M. (2015) · InTech eBooks · doi:10.5772/59418 · Cited by 5 · see citing works
Воробьева, О. В., Fateeva, V. V., Nikulina, K. V., Khacheva, K. K., Khakimova, G. R., & Epstein, O. I. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.88693 · Cited by 3 · see citing works
Sex and Gender Differences in Psychosocial Risk Factors for Ischemic Heart Disease
Mommersteeg, P. M. C., Widdershoven, J. W. M. G., & Kop, W. J. (2017) · Springer eBooks · doi:10.1007/978-3-319-54960-6_13 · Cited by 3 · see citing works
Hung, Y., Liu, C., & Hu, W.-L. (2015) · InTech eBooks · doi:10.5772/60704
Panic Disorder and Cardiovascular Death: What Is Beneath?
da Silva, C. T. B., & Manfro, G. G. (2016) · Springer eBooks · doi:10.1007/978-3-319-12538-1_12
Biological and Clinical Correlates of Vascular Risk in Adolescent Bipolar Disorder
Hatch, J. K. (2016) · TSpace (University of Toronto)
Kalogianni, A. (2019) · Health & Research Journal · doi:10.12681/healthresj.19701
Clinical phenotypes of comorbidities in end-stage knee osteoarthritis: a cluster analysisPreprint
Liu, R., Ma, J., Zhang, K., Ma, X., Wang, H., Ma, C., & Zhang, Y. (2023) · Research Square · doi:10.21203/rs.3.rs-3240468/v1
Huang, Z., Yi, X., Liu, X., He, Y., Huang, J., Liang, S., & Ming, W.-K. (2026) · Annals of General Psychiatry · doi:10.1186/s12991-026-00634-9
In vitro and in vivo study of the effects of Levetiracetam on activated microglia during sepsis
Fleurance, R. (2021) · theses.fr (ABES) · doi:10.70675/0a82ed6ez6595z4366z832fz70cbe839c7ff
- Authors
- Stillman, A. N., Moser, D. J., Fiedorowicz, J., Robinson, H. M., & Haynes, W. G.
- Affiliations
- University of Iowa (US)
- Corresponding author
- Moser, David J.
- Venue
- Psychosomatic Medicine
- Published
- 2013-07
- Volume
- 75
- Issue
- 6
- Pages
- 537-544
- ISSN
- 0033-3174 (ISSN-L)
- PMC
- PMC5042571
- OpenAlex
- W2329709943
- Cited by
- 29
- References
- 36
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 3 · 2021: 3 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 4 · 2016: 3 · 2015: 3 · 2014: 3
- FWCI
- 2.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000442, 5k23ag020649-02)
- National Institute on Aging (R01AG030417, K23-AG020649, 1K23AG020649-01A1)
- National Heart, Lung, and Blood Institute (HL-14388, P01HL014388)
- National Center for Research Resources (UL1RR024979)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- anxiety, atherosclerosis, vascular dysfunction, resistance vessels, forearm resistance vessels, flow-mediated dilation, endothelial function, acetylcholine-induced vasodilation, body mass index, older adults, cardiovascular risk
- MeSH terms
- Acetylcholine, Aged, Aged, 80 and over, Anxiety, Endothelium, Vascular, Female, Forearm, Humans, Male, Middle Aged, Muscle, Smooth, Vascular, Plethysmography, Vascular Resistance, Vasodilation, Vasodilator Agents, Case-Control Studies, Atherosclerosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
