Abstract
Several studies have suggested an increased risk of fatal coronary heart disease (CHD) among patients with panic disorder, phobic anxiety, and other anxiety disorders. We prospectively examined this association in the Normative Aging Study. An anxiety symptoms scale was constructed out of five items from the Cornell Medical Index, which was administered to the cohort at baseline. During 32 years of follow-up, we observed 402 cases of incident coronary heart disease (137 cases of nonfatal myocardial infarction, 134 cases of angina pectoris, and 131 cases of fatal CHD: made up of 26 cases of sudden cardiac death and 105 cases of nonsudden death). A nested case-control design (involving 1869 control subjects who remained free of diagnosed CHD) was used to assess the association between anxiety and risk of CHD. Compared with men reporting no symptoms of anxiety, men reporting two or more anxiety symptoms had elevated risks of fatal CHD (age-adjusted odds ratio [OR] = 3.20, 95% confidence interval [CI]: 1.27 to 8.09), and sudden death (age-adjusted OR = 5.73, 95% CI: 1.26 to 26.1). The multivariate OR after adjusting for a range of potential confounding variables was 1.94 (95% CI: 0.70-5.41) for fatal CHD and 4.46 (95% CI: 0.92-21.6) for sudden death. No excess risks were found for nonfatal myocardial infarction or angina. These data suggest an association between anxiety and fatal coronary heart disease, in particular, sudden cardiac death.
Highlights
Several studies have suggested an increased risk of fatal coronary heart disease (CHD) among patients with panic disorder, phobic anxiety, and other anxiety disorders
These data suggest an association between anxiety and fatal coronary heart disease, in particular, sudden cardiac death. (Circulation. 1994;90:2225-2229.)
Two prospective cohort studies have found a strong association between self-reported symptoms of phobic anxiety and risk of fatal coronary heart disease (CHD).4.5 In the Northwick Park Heart Study,[4] an ongoing cohort of 1457 British men, high levels of anxiety were associated with relative risks of fatal CHD of 3.77 (95% confidence interval [CI]: 1.64 to 8.64)
Summary
The Normative Aging Study is a longitudinal study of aging established by the Veteran Administration in 1961.10 The study cohort consists of 2280 community-dwelling men from the Greater Boston area who were aged 21 to 80 years at the time of entry. Volunteers were screened at entry according to health criteria,[10] and were free of known chronic medical conditions at the start of follow-up. In the first phase of screening, the Cornell Medical Index1" was administered to all participants. We constructed a fiveitem anxiety symptom scale out of questions selected from the Cornell Medical Index. The five individual items selected were similar to items included in existing, validated psychological assessment scales, such as the Brief Symptom Inventory,[12] the Spielberger State-Trait Anxiety Inventory,[13] the Hamilton Rating Scale for Anxiety,[14] and the Crown-Crisp index.[6] We selected the following five items to construct our anxiety scale: "Do strange people or places make you afraid?"; "Are you considered a nervous person?"; "Are you constantly keyed up and jittery?"; "Do you often become suddenly scared for no good reason?"; and "Do you often break out in a cold sweat?" The items were selected in an a priori manner, i.e., before any
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