title: Evidence for chronic low-grade systemic inflammation in individuals with agoraphobia from a population-based prospective study.
abstract: BACKGROUND
  Anxiety disorders have been linked to an increased risk of incident coronary heart disease in which inflammation plays a key pathogenic role. To date, no studies have looked at the association between proinflammatory markers and agoraphobia.
  
  
  METHODS
  In a random Swiss population sample of 2890 persons (35-67 years, 53% women), we diagnosed a total of 124 individuals (4.3%) with agoraphobia using a validated semi-structured psychiatric interview. We also assessed socioeconomic status, traditional cardiovascular risk factors (i.e., body mass index, hypertension, blood glucose levels, total cholesterol/high-density lipoprotein-cholesterol ratio), and health behaviors (i.e., smoking, alcohol consumption, and physical activity), and other major psychiatric diseases (other anxiety disorders, major depressive disorder, drug dependence) which were treated as covariates in linear regression models. Circulating levels of inflammatory markers, statistically controlled for the baseline demographic and health-related measures, were determined at a mean follow-up of 5.5 ± 0.4 years (range 4.7 - 8.5).
  
  
  RESULTS
  Individuals with agoraphobia had significantly higher follow-up levels of C-reactive protein (p = 0.007) and tumor-necrosis-factor-α (p = 0.042) as well as lower levels of the cardioprotective marker adiponectin (p = 0.032) than their non-agoraphobic counterparts. Follow-up levels of interleukin (IL)-1β and IL-6 did not significantly differ between the two groups.
  
  
  CONCLUSIONS
  Our results suggest an increase in chronic low-grade inflammation in agoraphobia over time. Such a mechanism might link agoraphobia with an increased risk of atherosclerosis and coronary heart disease, and needs to be tested in longitudinal studies.
authors: Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland.
authors: En-Young N
authors: EY
authors: Wagner
authors: Swissmedic, Division Clinical Review, Bern, Switzerland.
authors: Jan T
authors: JT
authors: Wagner
authors: Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland.
authors: Jennifer
authors: J
authors: Glaus
authors: Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland.
authors: Caroline L
authors: CL
authors: Vandeleur
authors: Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland.
authors: Enrique
authors: E
authors: Castelao
authors: Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland.
authors: Marie-Pierre F
authors: MP
authors: Strippoli
authors: Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors: Peter
authors: P
authors: Vollenweider
authors: Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Prilly, Switzerland.
authors: Martin
authors: M
authors: Preisig
authors: Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland; Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors: Roland
authors: R
authors: von Känel
mesh_terms: D000328:Adult; D000368:Aged; D000379:Agoraphobia / Q000150:complications* / Q000473:pathology*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011446:Prospective Studies