Author + information
- Received November 4, 2009
- Revision received January 28, 2010
- Accepted March 3, 2010
- Published online June 29, 2010.
- Annelieke M. Roest, MSc⁎,
- Elisabeth J. Martens, PhD⁎,
- Peter de Jonge, PhD⁎,† and
- Johan Denollet, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Johan Denollet, CoRPS, Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
Objectives The purpose of this study was to assess the association between anxiety and risk of coronary heart disease (CHD).
Background Less research has focused on the association of anxiety with incident CHD in contrast to other negative emotions, such as depression.
Methods A meta-analysis of references derived from PubMed, EMBASE, and PsycINFO (1980 to May 2009) was performed without language restrictions. End points were cardiac death, myocardial infarction (MI), and cardiac events. The authors selected prospective studies of (nonpsychiatric) cohorts of initially healthy persons in which anxiety was assessed at baseline.
Results Twenty studies reporting on incident CHD comprised 249,846 persons with a mean follow-up period of 11.2 years. Anxious persons were at risk of CHD (hazard ratio [HR] random: 1.26; 95% confidence interval [CI]: 1.15 to 1.38; p < 0.0001) and cardiac death (HR: 1.48; 95% CI: 1.14 to 1.92; p = 0.003), independent of demographic variables, biological risk factors, and health behaviors. There was a nonsignificant trend for an association between anxiety and nonfatal MI (HR: 1.43; 95% CI: 0.85 to 2.40; p = 0.180). Subgroup analyses did not show any significant differences regarding study characteristics, with significant associations for different types of anxiety, short- and long-term follow-up, and both men and women.
Conclusions Anxiety seemed to be an independent risk factor for incident CHD and cardiac mortality. Future research should examine the association between anxiety and CHD with valid and reliable anxiety measures and focus on the mechanisms through which anxiety might affect CHD.
Dr. de Jonge is supported by a VIDI grant from the Dutch Medical Research Council(grant 016.086.397). Dr. Denollet is supported by a VICI grant from the Dutch Organization for Scientific Research(grant 453.04.004).
- Received November 4, 2009.
- Revision received January 28, 2010.
- Accepted March 3, 2010.
- American College of Cardiology Foundation