Increased Risk of Coronary Heart Disease in Patients with Anxiety Disorders: A Review of Underlying Biomarkers

Abstract

Anxiety is the most common mental health disorder in the United States, affecting nearly a third of the population. As for depression, it is associated with increased risk of incident coronary heart disease (CHD) and poor cardiac prognosis. The pathophysiological mechanism underlying this "deleterious" association is not well defined. While several hypotheses have been proposed, few seem proven in original studies. A narrative literature review was thus performed to identify all original studies that looked at any biomarkers that can be implicated in the relation between anxiety and CHD. Surprisingly, only four cohorts or observational studies on anxiety and CHD reported biophysiopathological variables. Of the overall populations studied, only 15% were women. In term of biomarkers, plasma lipid levels, C-reactive protein, cortisol, norepinephrine, body mass index, blood pressure and heart rate variability were mostly not significantly different between anxious patients and controls. Only two variables, myocardial perfusion and coronary artery calcium, were found different between the two groups. In summary, underlying biomarkers explaining the increased risk of CHD in anxious patients are still poorly understood. Although based on very limited data, myocardial perfusion and coronary artery calcium seem to be plausible biomarkers. Clearly, more studies are needed to better understand this problematic, especially in women. This step is essential so that personalized care for patients with both anxiety and CHD can be implemented.