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

  • Published:
Annals of Behavioral Medicine

Abstract

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 years 1980–1996 on anxiety and CHD and relevant publications from earlier years were selected for this review. Epidemiologic evidence suggests that anxiety may be a risk factor for the development of CHD. Chronic anxiety may increase the risk of CHD by: (a) influencing health behaviors (e.g. smoking); (b) promoting atherogenesis (e.g. via increased risk of hypertension); and (c) triggering fatal coronary events, either through arrhythmia, plaque rupture, coronary vasospasm, or thrombosis. Electrophysiologic evidence is particularly compelling: anxiety appears to be associated with abnormal cardiac autonomic control, which may indicate increased risk of fatal ventricular arrhythmias. The strength, consistency, and dose-response gradient of the association between anxiety and CHD, together with the biologic plausibility of the experimental evidence, suggest that anxiety may contribute to risk of CHD and that the relationship warrants further investigation.

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Authors and Affiliations

  1. Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Avenue, 02115, Boston, MA

    Laura D. Kubzansky & Ichiro Kawachi

  2. Channing Laboratory, Brigham Women's Hospital Beth Israel Hospital and Harvard Medical School, Boston, USA

    Scott T. Weiss

Authors
  1. Laura D. Kubzansky
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  2. Ichiro Kawachi
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  3. Scott T. Weiss
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  4. David Sparrow
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Additional information

Department of Veterans Affairs Outpatient Clinic

Preparation of this manuscript was supported in part by Grants HL54098, HL45089, AG02287, and by the Health Services Research and Development Service of the Department of Veterans Affairs. Dr. Sparrow is an Associate Research Career Scientist of the Medical Research Service of the Department of Veterans Affairs. Dr. Kawachi is supported by a Career Development Award from the National Heart, Lung, and Blood Institute.

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Kubzansky, L.D., Kawachi, I., Weiss, S.T. et al. Anxiety and coronary heart disease: A synthesis of epidemiological, psychological, and experimental evidence. ann. behav. med. 20, 47–58 (1998). https://doi.org/10.1007/BF02884448

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