SYMPTOMS OF ANXIETY AND RISK OF CORONARY HEART-DISEASE - THE NORMATIVE AGING STUDY

Background Several studies have suggested an increased risk of fatal c oronary heart disease (CHD) among patients with panic disorder, phobic anxiety, and other anxiety disorders. We prospectively examined this association in the Normative Aging Study. Methods and Results An anxie ty symptoms scale was constructed out of five items from the Cornell M edical Index, which was administered to the cohort at baseline. During 32 years of follow-up, we observed 402 cases of incident coronary hea rt disease (137 cases of nonfatal myocardial infarction, 134 cases of angina pectoris, and 131 cases of fatal CHD - made up of 26 cases of s udden cardiac death and 105 cases of nonsudden death). A nested case-c ontrol design (involving 1869 control subjects who remained free of di agnosed CHD) was used to assess the association between anxiety and ri sk of CHD. Compared with men reporting no symptoms of anxiety, men rep orting two or more anxiety symptoms had elevated risks of fatal CHD (a ge-adjusted odds ratio [OR]=3.20, 95% confidence interval [CI]: 1.27 t o 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 confoun ding 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 nonf atal myocardial infarction or angina. Conclusions These data suggest a n association between anxiety and fatal coronary heart disease, in par ticular, sudden cardiac death.