Anxiety and coronary heart disease: A synthesis of epidemiological, psychological, and experimental evidence

The purpose of this review is to examine the epidemiological, psychological , and experimental evidence for an association between anxiety and coronary heart disease (CHD). Papers published during the pears 1980-1996 on anxiet y and CHD and relevant publications from earlier years were selected for th is review: Epidemiologic evidence suggests that anxiety may be a risk facto r for the development of CHD. Chronic anxiety may increase the risk of CHD by: (a) influencing health behaviors (e.g. smoking); (b) promoting atheroge nesis (e.g. via increased risk of hypertension); and (c) triggering fatal c oronary events, either through arrhythmia, plaque rupture, coronary vasospa sm, or thrombosis. Electrophysiologic evidence is particularly compelling: anxiety appears to be associated with abnormal cardiac autonomic control, w hich may indicate increased risk of fatal ventricular arrhythmias. The stre ngth, consistency and dose-response gradient of the association between anx iety and CHD, together with the biologic plausibility of the experimental e vidence, suggest that anxiety may contribute to risk of CHD and that the re lationship warrants further investigation.