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Anxiety and cardiovascular risk

follow-up period, anxiety and depression, but not anger, remained independent predictors. These findings support the need to consider these specific emotions separately. It may also be that general distress in and of itself is an important CV risk factor.


A growing body of evidence indicates that psychosocial factors may be considered as major CHD risk factors in a similar way to the traditional risk factors (hypertension, diabetes, hyperlipidemia, smoking, obesity, physical inactiv- ity, and age). This notion is supported by the multinational INTERHEART casecontrol study of 29972 patients from 52 countries, which uniquely assessed the impact of eight coronary risk factors and a composite index of psychosocial factors on incident acute MI.16 Psychosocial distress con- ferred a greater adjusted relative risk of acute MI than hypertension, abdominal obesity, diabetes, and several other traditional risk factors. In addition, psychosocial distress was a predictor of acute MI independent of ethnic or geographic context107. This important finding, along with reports from the Framingham study,95,108 suggests that psychosocial factors may be equivalent to traditional risk factors in predicting CV events, although more studies are needed in this area.


With the limited evidence available, anxiety appears to predict more CV symptoms, poorer functional status, and increased CV events. More experimental and randomized clinical trials are needed to fully understand the relationship between anxiety and CV disease, as well as to determine whether the proposed pathophysiological mechanisms are truly causal. Clinical evaluation of cardiac patients should include assessment of psychosocial factors, most especially anxiety and depression. Further research in this area should concentrate on teasing out the mechanisms by which individual psychosocial factors increase CV risk, and also focus on interventions that decrease both anxiety and adverse CV events.

Disclosure: No conflict of interest to be reported. Acknowledgements: This research was supported by funding from

the NIH/NCMHD (R01MD004113 and P20MD005092).

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M&B 2011; 2:(1). July 2011

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