title: Anxiety characteristics independently and prospectively predict myocardial infarction in men the unique contribution of anxiety among psychologic factors.
abstract: OBJECTIVE
  This study investigated whether anxiety characteristics independently predicted the onset of myocardial infarction (MI) over an average of 12.4 years and whether this relationship was independent of other psychologic variables and risk factors.
  
  
  BACKGROUND
  Although several psychosocial factors have been associated with risk for MI, anxiety has not been examined extensively. Earlier studies also rarely addressed whether the association between a psychologic variable and MI was specific and independent of other psychosocial correlates.
  
  
  METHODS
  Participants were 735 older men (mean age 60 years) without a history of coronary disease or diabetes at baseline from the Normative Aging Study. Anxiety characteristics were assessed with 4 scales (psychasthenia, social introversion, phobia, and manifest anxiety) and an overall anxiety factor derived from these scales.
  
  
  RESULTS
  Anxiety characteristics independently and prospectively predicted MI incidence after controlling for age, education, marital status, fasting glucose, body mass index, high-density lipoprotein cholesterol, and systolic blood pressure in proportional hazards models. The adjusted relative risk (95% confidence interval [CI]) of MI associated with each standard deviation increase in anxiety variable was 1.37 (95% CI 1.12 to 1.68) for psychasthenia, 1.31 (95% CI 1.05 to 1.63) for social introversion, 1.36 (95% CI 1.10 to 1.68) for phobia, 1.42 (95% CI 1.14 to 1.76) for manifest anxiety, and 1.43 (95% CI 1.17 to 1.75) for overall anxiety. These relationships remained significant after further adjusting for health behaviors (drinking, smoking, and caloric intake), medications for hypertension, high cholesterol, and diabetes during follow-up and additional psychologic variables (depression, type A behavior, hostility, anger, and negative emotion).
  
  
  CONCLUSIONS
  Anxiety-prone dispositions appear to be a robust and independent risk factor of MI among older men.
authors.affiliation: Department of Psychology, University of Southern California, Los Angeles, California 90089-1061, USA. bjshen@usc.edu
authors.forename: Biing-Jiun
authors.initials: BJ
authors.lastname: Shen
authors.forename: Yael E
authors.initials: YE
authors.lastname: Avivi
authors.forename: John F
authors.initials: JF
authors.lastname: Todaro
authors.forename: Avron
authors.initials: A
authors.lastname: Spiro
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Laurenceau
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
authors.forename: Raymond
authors.initials: R
authors.lastname: Niaura
mesh_terms: D017677:Age Distribution; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D010808:Physical Examination; D011237:Predictive Value of Tests; D015995:Prevalence; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011594:Psychometrics; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013315:Stress, Psychological; D016019:Survival Analysis; D014434:Type A Personality