title: Reflex syncope, anxiety level, and family history of cardiovascular disease in young women: case-control study.
abstract: OBJECTIVE
  Anxiety is an emotion, which stimulates sympathetic nervous outflow potentially facilitating vasovagal reflex syncope (VVS) but reports on anxiety levels in patients with VVS are sparse.
  
  
  RESULTS
  We studied anxiety levels in young women (21-40 years) referred for unexplained transient loss of consciousness (TLOC), and age-matched female controls with or without past history of TLOC (≈probable VVS). Referred patients underwent head-up tilt (HUT) according to current ESC Guidelines. State and Trait Anxiety Inventory questionnaire evaluated anxiety levels plus a questionnaire explored risk factors for cardiovascular disease (CVD). Sixty-five of 91 women were diagnosed with VVS on HUT. Among 549 controls, 223 (40.6%) reported at least one episode of TLOC. State-anxiety level in patients with VVS undergoing HUT (42.4 ± 9.3) was higher compared with both controls with (38.3 ± 10.2; P < 0.01) and without past TLOC history (35.9 ± 9.8; P < 0.001). Trait anxiety in patients with VVS (42.7 ± 8.4), and controls with TLOC history (42.4 ± 8.4) was higher compared with controls without TLOC history (39.7 ± 8.5; P < 0.01). In the logistic regression using controls without TLOC as reference, both VVS diagnosis and past history of TLOC were associated with family history of CVD [odds ratio (OR) 2.4, 95% confidence interval (CI), 1.3-4.4; P = 0.007, and 2.3, 1.4-3.6; P = 0.001, respectively], and this association was independent of anxiety level.
  
  
  CONCLUSIONS
  Trait anxiety and family history of CVD are increased in both young women with VVS and controls with history of TLOC. However, the height of anxiety level does not explain CVD heredity and other mechanisms may link syncope with CVD.
authors.affiliation: Department of Emergency Medicine, Wroclaw Medical University, Wroclaw 51-618, Poland dzysko@wp.pl.
authors.forename: D
authors.initials: D
authors.lastname: Zyśko
authors.affiliation: Department of Psychiatry, Wroclaw Medical University, Wroclaw 50-367, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Szewczuk-Bogusławska
authors.affiliation: Center of Neuropsychiatry 'Neuromed', Białowieska 74A, Wroclaw 54-235, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Kaczmarek
authors.affiliation: 2nd Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw 50-556, Poland.
authors.forename: A K
authors.initials: AK
authors.lastname: Agrawal
authors.affiliation: Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University, Wroclaw 50-556, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Rudnicki
authors.affiliation: Department of Cardiology, Wroclaw Medical University, Wroclaw 50-556, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Gajek
authors.affiliation: Department of Clinical Sciences, Lund University, Clinical Research Center, Skåne University Hospital, Malmö 205-02, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Melander
authors.affiliation: National Heart and Lung Institute, Imperial College, St Mary's Hospital Campus, 59-61 North Wharf Road, London W2 1LA, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sutton
authors.affiliation: Department of Clinical Sciences, Lund University, Clinical Research Center, Skåne University Hospital, Malmö 205-02, Sweden Arrhythmia Department, Skåne University Hospital, Malmö 205-02, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Fedorowski
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016022:Case-Control Studies; D005190:Family; D005260:Female; D006801:Humans; D016015:Logistic Models; D010551:Personality; D019462:Syncope, Vasovagal / Q000453:epidemiology / Q000523:psychology*; D018667:Tilt-Table Test; D055815:Young Adult
keywords: Anxiety; Cardiovascular disease; Risk factors; Syncope; Vasovagal