Meta-Analysis of Anxiety as a Risk Factor for Cardiovascular Disease.
Whether anxiety is a risk factor for a range of cardiovascular diseases is unclear. We aimed to determine the association between anxiety and a range of cardiovascular diseases. MEDLINE and EMBASE were searched for cohort studies that included participants with and without anxiety, including subjects with anxiety, worry, posttraumatic stress disorder, phobic anxiety, and panic disorder. We examined the association of anxiety with cardiovascular mortality, major cardiovascular events (defined as the composite of cardiovascular death, stroke, coronary heart disease, and heart failure), stroke, coronary heart disease, heart failure, and atrial fibrillation. We identified 46 cohort studies containing 2,017,276 participants and 222,253 subjects with anxiety. Anxiety was associated with a significantly elevated risk of cardiovascular mortality (relative risk [RR] 1.41, CI 1.13 to 1.76), coronary heart disease (RR 1.41, CI 1.23 to 1.61), stroke (RR 1.71, CI 1.18 to 2.50), and heart failure (RR 1.35, CI 1.11 to 1.64). Anxiety was not significantly associated with major cardiovascular events or atrial fibrillation although CIs were wide. Phobic anxiety was associated with a higher risk of coronary heart disease than other anxiety disorders, and posttraumatic stress disorder was associated with a higher risk of stroke. Results were broadly consistent in sensitivity analyses. Anxiety disorders are associated with an elevated risk of a range of different cardiovascular events, including stroke, coronary heart disease, heart failure, and cardiovascular death. Whether these associations are causal is unclear.
Nuffield Department of Population Health, St John's College, University of Oxford, Oxford, United Kingdom. Electronic address: connor.emdin@sjc.ox.ac.uk.
Connor A
CA
Emdin
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.
Ayodele
A
Odutayo
Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
Christopher X
CX
Wong
Nuffield Department of Obstetrics and Gynaecology, Green Templeton College, University of Oxford, Oxford, United Kingdom.
Jenny
J
Tran
Department of Economics, Massachusetts Institute of Technology, Boston, Massachusetts.
Allan J
AJ
Hsiao
Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom; Department of Medicine, University of Tasmania, Hobart, Australia.
Benjamin H M
BH
Hunn
D001007:Anxiety / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D016022:Case-Control Studies; D003327:Coronary Disease / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D009026:Mortality; D016584:Panic Disorder / Q000453:epidemiology*; D010698:Phobic Disorders / Q000453:epidemiology*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology