Harvard Mental Health Letter

Anxiety and heart disease

While there is a well-known relationship between major depression and cardiovascular disease, much less is known about how anxiety disorders affect the heart. Various studies have found that 24% to 31% of patients with cardiovascular disease have symptoms of anxiety. Moreover, severe anxiety — which may manifest as a panic attack — can mimic a heart attack. One analysis of studies involving people admitted to emergency rooms for chest pain found that 22% of those who underwent cardiovascular testing had panic disorder rather than heart disease. Most research on anxiety and heart disease is flawed, relying on participants' recollections or single objective "snapshot" assessments rather than using structured interviews to diagnose anxiety. Many studies have also lacked controls for factors such as lifestyle that could affect heart disease risk. Two prospective studies followed large numbers of participants over time to better examine the relationship between heart disease and one of the most common anxiety disorders, generalized anxiety disorder — characterized by constant and pervasive anxiety, even about mundane matters. A particular strength of these studies is that they controlled for confounding factors such as major depression (which often occurs in conjunction with anxiety) and demographic and lifestyle factors that affect heart disease risk. Both suggest that generalized anxiety disorder may indeed increase risk of heart attacks and other adverse events.
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