CHICAGO — Patients with coronary artery disease who experience a declining or even steady level of anxiety over time have a significantly lower risk of nonfatal myocardial infarction or death, compared with those experiencing escalating anxiety, according to a prospective observational cohort study.
The finding doesn't prove cause and effect but does support the hypothesis that a systematic effort to lower the anxiety level of CAD patients with pharmacotherapy and/or psychotherapy may result in improved cardiovascular outcomes—a hypothesis deserving of a definitive randomized, controlled trial, Yinong Young-Xu, Ph.D., said at the annual meeting of the American College of Cardiology.
Dr. Young-Xu, of the Lown Cardiovascular Research Foundation, Brookline, Mass., reported on 516 patients with CAD in an outpatient cardiology clinic whose anxiety level was assessed annually by means of the 92-question self-administered Kellner Symptom Questionnaire. On the basis of their scores, participants were categorized at baseline as having a low, intermediate, or high anxiety level.
During a mean 3.4 years of follow-up, 44 patients had a nonfatal MI and 19 others died. The age-adjusted relative risk of these outcomes was 61% lower in patients whose anxiety level decreased by at least one tertile during follow-up, compared with those who moved into a higher tertile of anxiety. Patients who remained in the same anxiety tertile over the years had a 51% lower risk of the combined end point, compared with those whose anxiety level increased.
In a multivariate analysis adjusted for diabetes, hypertension, cholesterol level, body mass index, education level, alcohol intake, physical activity, ejection fraction, marital status, and other potential confounders, the reduced risk of death or MI in those with a steady or declining anxiety level held true. Prior studies that have linked emotional distress to increased cardiac risks have focused on depression, not anxiety, he noted.