Older men who suffer from chronic anxiety substantially increase their risk of having a heart attack, say researchers in a recent study.

While stress has been linked to an increased risk for heart problems, this is the first time that chronic anxiety has been identified as a risk factor also.

"There is an independent contribution of anxiety that can predict the onset of a heart attack among healthy older men," said lead researcher Biing-Jiun Shen, PhD, an assistant professor of psychology at the University of Southern California in Los Angeles.

Even after accounting for anger, hostility, depression and type A personality, anxiety still predicted the onset of a heart attack, Dr. Shen said. "The relationship between anxiety and heart attack cannot be explained by depression, hostility or type A personality."

The Study

In the study, Dr. Shen's group collected data on 735 men who participated in the Normative Aging Study, which assesses medical and psychological changes associated with aging.

Each of these men completed psychological testing in 1986 and had no heart problems at the time. The men were followed for an average of 12 years.

During follow-up, the researchers discovered men with chronic anxiety had a 30% to 40% increased risk for heart attack. Those with the highest levels of anxiety on psychological testing had an even higher risk for heart attack.

The risk posed by anxiety remained even after the researchers adjusted their data to account for standard cardiovascular risk factors, health habits, and negative psychological and personality traits, Dr. Shen said.


Exaggerated response to acute and chronic stress in anxious individuals may trigger a number of pathways that increase the risk of developing coronary artery disease and being stricken with a heart attack, said Gregg C. Fonarow, MD, a professor of cardiology at the University of California, Los Angeles.

Whether treating anxiety reduces the risk of heart attack isn't known, Dr. Shen said. "But the implication is there," he added, "It is something that doctors can look out for." Dr. Shen's team is hoping to study that possibility.

In addition, it isn't known if women are also at risk for heart attack from chronic anxiety, Dr. Shen noted.

Expert Reaction To Study Results

Dr. Fonarow agreed that psychological factors play a significant role in the risk for having a heart attack.

"Psychological characteristics including anxiety, anger, hostility and type A personalities have been associated with increased risk of heart attack in a number of prior studies, and this study again shows that chronic anxiety appears to raise an individual's heart attack risk," said Dr. Fonarow.

"An important finding of this study is that anxiety not only represents an independent risk factor for heart attack but may also explain the associations between heart attack risk and other psychosocial risk factors," he explained.

Self-Defense From Dr. Fonarow

"Highly anxious individuals should be aware they may face an increased risk of a heart attack and take proactive steps under physician supervision to control those cardiovascular risk factors which are modifiable, including blood pressure, lipid levels, activity level and weight," Dr. Fonarow added.

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