Anxiety and Incident Cardiovascular Disease: Is the Jury Still Out?

Anxiety disorders are prolific and burdensome globally. Anxiety is a troubling clinical presentation for the cardiologist because of high emergency department recidivism, unnecessary diagnostic work-ups, and follow-up appointments to rule out “organic” disease causes. The recent systematic review by Emdin et al included studies utilizing self-report to determine cardiovascular disease (CVD) status (e.g., in the past 3 years, have you been diagnosed or treated for heart disease, including heart attack, angina?), therefore reducing confidence in their findings. Self-reports of CVDs are unreliable in anxious patients, and panic disorder is associated with catastrophic misinterpretation of bodily symptoms including chest pain. Depression is also common in anxious patients, concurrently and across the lifespan. Emdin et al state “Despite the substantial evidence that depression and general psychological distress are associated with incident cardiovascular disease.” Yet neither was considered in their main or sensitivity analysis, questioning the independent contribution of anxiety to incident CVD risk.