Annals of Behavioral Medicine

, Volume 20, Issue 2, pp 47–58

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


  • Laura D. Kubzansky
    • Department of Health and Social BehaviorHarvard School of Public Health
  • Ichiro Kawachi
    • Department of Health and Social BehaviorHarvard School of Public Health
  • Scott T. Weiss
    • Channing LaboratoryBrigham Women's Hospital Beth Israel Hospital and Harvard Medical School
  • David Sparrow

DOI: 10.1007/BF02884448

Cite this article as:
Kubzansky, L.D., Kawachi, I., Weiss, S.T. et al. ann. behav. med. (1998) 20: 47. doi:10.1007/BF02884448


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.

Copyright information

© The Society of Behavioral Medicine 1998