26.01.2016
Mind and Heart work in an interconnected way, perhaps more than between any other organs . Allgulander reviews the relationship between anxiety and cardiac heath in this article
Anxiety is a risk factor for cardiac morbidity. A large scale study ( with 52 095 participants in 19 countries) reported in 2013 that after adjusting for comorbidity, diagnoses of depression,panic disorder, specific phobia, posttraumaticstress disorder, and alcohol use disorders were associated with heart disease onset [odds ratios(ORs) 1.3–1.6]. (Scott et al 2013 ). Associations with anxiety were greater in magnitude than those with depression.
A swedish military conscript study showed that anxiety state at age 18- 20 increased the risk of MI at follow up ( average 37 years) by more than 2 fold (Janzsky ,2008). A Taiawanse study found that nearly 5% of those with panic disorder were to develop MI in the next year ( compared to control rate of nearly 3%).
Prospective studies have shown that individuals with cardiac disorders do worse when they also suffer from anxiety.
What about acute physiological changes related to anxiety?
Takotsubo cardiomyopathy ( ‘broken heart’ syndrome) was first reported in Japan. Takotsubo is a trap used to catch octopus and has a narrow neck and a round bottom. Left ventricle temporarily become weak and its shape changes. Majority of people with this ‘heart attack’ have experienced emotional stress. The condition is temporary and reversible. Left ventricle will return to normal shape in days/weeks. Pre existing anxiety and depression are reported more often among sufferers.
White coat hypertension is tother condition to be considered here. Reports suggest that this may not be benign, i.e. it is associated with other pathological changes.It may have a social anxiety component , but there are no studies to delineate different contributors.
Exposure to both acute and chronic mental stress is associated with an increased incidence of adverse cardiac events. Imminent missile attacks, natural disasters, football match days, start of working week especially after holidays – all are shown to increase cardiac events. Mental stress induced myocardial schema (MSMI) is an important current area of research.Mental stress triggers transient myocardial ischaemia in 30–70% of patients withpre-existing CAD. A 2014 metaanalysis (Wei et al 2014) showed that MSIMI was associated with a twofold increased risk of a combined end point of cardiac events or total mortality.
Conclusions
Anxiety is a risk factor for cardiac morbidity. Anxiety adversely affects cardiac patients. Recognition and treatment of anxiety is important in improving the outcomes in cardiac disorders.
Summary of the article :
Anxiety as a risk factor in cardiovascular disease. Allgulander C.
Curr Opin Psychiatry. 2016 Jan;29(1):13-17.
