title: Anxiety disorders and risk of stroke: A systematic review and meta-analysis.
abstract: Anxiety disorders are the most common mental health problem worldwide. However, the evidence on the association between anxiety disorders and risk of stroke is limited. This systematic review and meta-analysis presents a critical appraisal and summary of the available evidence on the association between anxiety disorders and risk of stroke.
  
  
  
  Cohort studies reporting risk of stroke among patients with anxiety disorders were searched in PubMed, Embase, PsycINFO, Scopus, and the Web of Science, from database inception to June 2016. The quality of the studies was assessed using standard criteria. A meta-analysis was undertaken to obtain pooled estimates of the risk of stroke among patients with anxiety disorders.
  
  
  
  Eight studies, including 950,759 patients, from the 11,764 references initially identified, were included in this review. A significantly increased risk of stroke for patients with anxiety disorders was observed, with an overall hazard ratio: 1.24 (1.09-1.41), P=0.001. No significant heterogeneity between studies was detected and the funnel plot suggested that publication bias was unlikely. Limited evidence suggests that the risk of stroke is increased shortly after the diagnosis of anxiety and that risk of stroke may be higher for patients with severe anxiety.
  
  
  
  Anxiety disorders are a very prevalent modifiable condition associated with risk of stroke increased by 24%. This evidence could inform the development of interventions for the management of anxiety and the prevention of stroke. Further studies on the risk of stroke in patients with anxiety, and the explanatory factors for this association, are required.
authors.affiliation: The Westborough Road Health Centre, Westcliff on Sea, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Piñar
authors.affiliation: The Westborough Road Health Centre, Westcliff on Sea, United Kingdom; Centre of Primary Care and Public Health, Queen Mary University of London, London, United Kingdom. Electronic address: l.garcia-morzon@qmul.ac.uk.
authors.forename: L
authors.initials: L
authors.lastname: Ayerbe
authors.affiliation: Primary Care Unit, Department of Medicine, Autonoma University of Madrid, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: González
authors.affiliation: Centre of Primary Care and Public Health, Queen Mary University of London, London, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Mathur
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.
authors.forename: Q
authors.initials: Q
authors.lastname: Foguet-Boreu
authors.affiliation: Division of Health and Social Care, Kings College London, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Ayis
mesh_terms: D001007:Anxiety / Q000150:complications*; D001008:Anxiety Disorders / Q000150:complications*; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D012306:Risk; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control
keywords: Anxiety disorders; Cohort studies; Stroke; Systematic review