Anxiety and Cardiovascular Disease

Abstract

This chapter examines the association of anxiety disorders and anxiety symptoms with cardiovascular disease, focussing on hypertension (an independent risk factor for myocardial infarction and stroke) and coronary heart disease. In both cases, epidemiological data linking the cardiovascular disorder with specific anxiety disorders and anxiety symptoms are examined first, and evidence relating to putative mechanisms that may underlie these associations is explored. For hypertension, an association with panic attacks and panic disorder has been reported most consistently, but the literature relating to other forms of anxiety is inconsistent, especially as some studies have reported an association of anxiety with low blood pressure. Recent work which has attempted to elucidate this confusing situation is presented. Mechanisms which may be responsible for the link between hypertension and panic include autonomic nervous system dysfunction (which may be under serotonergic control), respiratory mechanisms, cytokines, platelet dysfunction and behavioural factors. While an association of depression with coronary heart disease has been studied extensively, the association with anxiety disorders has been slower to emerge. Studies contributing to this evidence base are examined, and as for hypertension putative mechanisms are discussed.

Sympathetic activation and endothelial dysfunction in polycystic ovary syndrome are not explained by either obesity or insulin resistance

“…A recent meta‐analysis indicated that women with PCOS tend to experience mildly elevated levels of anxiety and depression, significantly more than women without PCOS . Anxiety and depression are linked to sympathetic dysfunction, in particular with an abnormal sympathetic nerve firing pattern, and elevated cardiovascular risk . In the present study, however, state and trait anxiety did not differ between the two groups of women.…”

Risk of incident cardiovascular events amongst individuals with anxiety and depression: A prospective cohort study in the east London primary care database

“…While the relationship between severe mental illness and cardiovascular disease has been widely explored, there is a paucity of evidence around the relationship between anxiety and incident cardiovascular events. (Bowen et al, 2000;Davies and Allgulander, 2013;Lambiase et al, 2014;Osborn et al, 2007) The burden of CVD and CVD risk factors is increasing rapidly amongst young, working-age adults. (Lavie and Milani, 2006;Moran et al, 2014;Poisson et al, 2014) Since cardiovascular disease is the leading cause of loss of in disability adjusted lifeyears (DALYs) worldwide, this represents the greatest loss for families and national economies.…”

Selected psychological comorbidities in coronary heart disease: Challenges and grand opportunities.

“…Individuals with high levels of chronic stress, anxiety, and sleep problems also show many of the same CHD-relevant biological patterns noted above, including cardiac autonomic dysfunction, impaired endothelial functioning, low-grade inflammation, and platelet hyperactivity (Davies & Allgulander, 2013; Edmondson & Cohen, 2013; Everson-Rose & Lewis, 2005; Motivala, 2011; Steptoe & Kivimaki, 2012). However, much of the evidence regarding these associations derives from studies of otherwise healthy individuals.…”