Anxiety Characteristics Independently and Prospectively Predict Myocardial Infarction in Men: The Unique Contribution of Anxiety Among Psychologic Factors Biing-Jiun Shen, Yael E. Avivi, John F. Todaro, Avron Spiro, III, Jean-Philippe Laurenceau, Kenneth D. Ward, and Raymond Niaura J. Am. Coll. Cardiol. 2008;51;113-119 doi:10.1016/j.jacc.2007.09.033

Department of Psychology, University of Southern California, Los Angeles, California 90089-1061, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 02/2008; 51(2):113-9. DOI: 10.1016/j.jacc.2007.09.033
Source: PubMed


This study investigated whether anxiety characteristics independently predicted the onset of myocardial infarction (MI) over an average of 12.4 years and whether this relationship was independent of other psychologic variables and risk factors.
Although several psychosocial factors have been associated with risk for MI, anxiety has not been examined extensively. Earlier studies also rarely addressed whether the association between a psychologic variable and MI was specific and independent of other psychosocial correlates.
Participants were 735 older men (mean age 60 years) without a history of coronary disease or diabetes at baseline from the Normative Aging Study. Anxiety characteristics were assessed with 4 scales (psychasthenia, social introversion, phobia, and manifest anxiety) and an overall anxiety factor derived from these scales.
Anxiety characteristics independently and prospectively predicted MI incidence after controlling for age, education, marital status, fasting glucose, body mass index, high-density lipoprotein cholesterol, and systolic blood pressure in proportional hazards models. The adjusted relative risk (95% confidence interval [CI]) of MI associated with each standard deviation increase in anxiety variable was 1.37 (95% CI 1.12 to 1.68) for psychasthenia, 1.31 (95% CI 1.05 to 1.63) for social introversion, 1.36 (95% CI 1.10 to 1.68) for phobia, 1.42 (95% CI 1.14 to 1.76) for manifest anxiety, and 1.43 (95% CI 1.17 to 1.75) for overall anxiety. These relationships remained significant after further adjusting for health behaviors (drinking, smoking, and caloric intake), medications for hypertension, high cholesterol, and diabetes during follow-up and additional psychologic variables (depression, type A behavior, hostility, anger, and negative emotion).
Anxiety-prone dispositions appear to be a robust and independent risk factor of MI among older men.

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Available from: Kenneth D Ward, Oct 06, 2015
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    • "The eleven prospective studies found that the presence of a depressive disorder was associated with major cardiac events with a relative risk of 2.69 [17], compared to the Framingham Heart Study, in which hypertension was associated with the same major cardiac events with a relative risk of 1.92 [18]. In a normative aging study, 735 men over sixty with no coronary/artery diseases were evaluated to verify the presence of anxiety symptoms; after 12 years, the anxiety level measured at baseline proved to be associated with myocardial infarction with a relative risk of 1.43 [19]. "
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    ABSTRACT: It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients' wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS), the Cognitive Behavioural Assessment Hospital Form (CBA-H), the Beck Depression Inventory (BDI), the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9), the Depression Interview and Structured Hamilton (DISH), the Hamilton Rating Scale for Depression (HAM-D/HRSD), and the Composite International Diagnostic Interview (CIDI). Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.
    Depression research and treatment 02/2014; 2014:148256. DOI:10.1155/2014/148256
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    • "Anxiety, chronic anxiety in particular, has been linked to the development of disease [36]. Contrary to what would be expected, chronic anxiety has been shown to be negatively associated with cardiovascular reactivity [15]. "
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    ABSTRACT: Although several studies have shown that enhanced cardiovascular reactivity can predict hypertension development in African Americans, these findings have not been consistent among all studies examining reactivity and hypertension susceptibility. This inconsistency may be explained by the influence of anxiety (state and trait) on the blood pressure response to stress. Therefore, this study sought to determine whether anxiety is associated with blood pressure response to cold pressor (CP) and anger recall (AR) stress tests in young healthy African Americans. Modeling using state and trait anxiety revealed that state anxiety predicts systolic (SBP) and diastolic blood pressure DBP response to CP and AR (P ≤ 0.02). Interestingly, state anxiety predicted heart rate changes only to CP (P < 0.01; P = 0.3 for AR). Although trait anxiety was associated with SBP response to AR and not CP, it was not a significant predictor of reactivity in our models. We conclude that anxiety levels may contribute to the variable blood pressure response to acute stressors and, therefore, should be assessed when performing cardiovascular reactivity measures.
    01/2012; 2012:268013. DOI:10.1155/2012/268013
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    • "Neuroticism was perhaps the personality dimension that was expected to be associated with disease severity because its associations with anxiety, emotional instability, and depressiveness [24]. Anxiety as a separate emotion has been associated with an increased risk of incident MI in older men [44] and is estimated to be as high as 70-80% among patients that have experienced an acute cardiac event [45]. Our results did not indicate associations between severity and neuroticism which could be explained by the fact that the study cohort was substantially circumscribed because a majority of the SECAMI-patients were not fit to participate in the serial CWT. "
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    ABSTRACT: Psychosocial stress has been identified as a risk factor in association with cardiovascular disease but less attention has been paid to heterogeneity in vulnerability to stress. The serial Color Word Test (CWT) measures adaptation to a stressful situation and it can be used to identify individuals that are vulnerable to stress. Prospective studies have shown that individuals with a maladaptive behavior in this test are exposed to an increased risk of future cardiovascular events. The aim of the present study was to investigate whether maladaptive behavior in the serial CWT alone or in combination with any specific personality dimension was associated with severity of myocardial infarction (MI). MI-patients (n = 147) completed the test and filled in a personality questionnaire in close proximity to the acute event. The results were analyzed in association with four indicators of severity: maximum levels above median of the cardiac biomarkers troponin I and creatine kinase-MB (CKMB), Q-wave infarctions, and a left ventricular ejection fraction (LVEF) ≤ 50%. Maladaptive behavior in the serial CWT together with low scores on extraversion were associated with maximum levels above median of cardiac troponin I (OR 2.97, CI 1.08-8.20, p = 0.04) and CKMB (OR 3.33, CI 1.12-9.93, p = 0.03). No associations were found between the combination maladaptive behavior and low scores on extraversion and Q-wave infarctions or a decreased LVEF. Maladaptive behavior in combination with low scores on extraversion is associated with higher cardiac biomarker levels following an MI. The serial CWT and personality questionnaires could be used to identify individuals vulnerable to the hazardous effects of stress and thereby are exposed to an increased risk of a more severe infarction.
    BMC Cardiovascular Disorders 07/2011; 11(1):45. DOI:10.1186/1471-2261-11-45 · 1.88 Impact Factor
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