title: Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham Offspring Study.
abstract: OBJECTIVE
  Conflicting research findings regarding the ability of tension or anxiety to predict incident coronary heart disease (CHD) have created uncertainty in the literature. In addition, there are no prospective studies relating these characteristics to the development of atrial fibrillation (AF).
  
  
  METHODS
  From 1984 to 1987, 3682 participants (mean age 48.5 +/- 10.1 year; 52% women) of the Framingham Offspring Study were examined and followed for 10 years for the incidence of CHD, AF, and total mortality. Measures of tension, anxiety, and risk factors for CHD and AF were collected at the baseline examination.
  
  
  RESULTS
  After adjusting for age, systolic blood pressure, body mass index, current cigarette smoking, diabetes, and total cholesterol/high-density cholesterol in Cox proportional hazards models, increased tension was predictive of 10-year incidence of definite CHD (relative risk (RR) = 1.25 relative to a one SD difference; 95% confidence interval (CI), 1.05-1.49) and total mortality (RR = 1.23; 95% CI, 1.06-1.42) in men. After adjusting for AF risk factors, tension also predicted AF in men (RR = 1.24; 95% CI, 1.04-1.48). Anxiety in men (RR = 1.22; 95% CI, 1.08-1.38), and in women (RR = 1.27; 95% CI, 1.05-1.55) was significantly related to total mortality.
  
  
  CONCLUSIONS
  Tension was observed to be an independent risk factor for incident CHD, AF, and mortality in men. Anxiety was a risk factor for total mortality in men and women. Our findings suggest that further research into the pathophysiology of the excess morbidity and mortality observed with tension and anxiety is merited.
authors.affiliation: Eaker Epidemiology Enterprises, LLC, Chili, Wisconsin 54420, USA. eakerepi@tznet.com
authors.forename: Elaine D
authors.initials: ED
authors.lastname: Eaker
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sullivan
authors.forename: Margaret
authors.initials: M
authors.lastname: Kelly-Hayes
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology