ANXIETY DISORDER AND HEART DISEASE Anxiety Anxiety is an unpleasant state of inner turmoil, often accompanied by nervous behavior, such as pacing back and forth, somatic complaints and rumination. It can also be used as a general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how we feel and behave, and they can manifest real physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can be extremely debilitating, having a serious impact on daily life. Anxiety is not the same as fear, which is felt about something realistically intimidating or dangerous and is an appropriate response to perceived threat. People often experience a general state of worry or fear before confronting something challenging such as a test, examination, recital, or interview. These feelings are easily justified and considered normal. Anxiety becomes a disorder when symptoms interfere with a persons ability to sleep or otherwise function. Generally speaking, anxiety occurs when a reaction is out of proportion with what might be normally expected in a situation. There are many types of anxiety disorders including panic disorder, obsessive compulsive behavior, post-traumatic stress disorder, social anxiety, specific phobia, and generalized anxiety disorder. Heart disease Heart disease is a broad term used to describe a range of diseases that affect the heart. The various diseases that fall under the umbrella of heart disease include diseases of the blood vessels, such as coronary artery disease; heart rhythm problems (arrhythmias); heart infections; and congenital heart defects. The term heart disease is often used interchangeably with cardiovascular disease. Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to myocardial infarction, angina (chest pain) or stroke. Other heart conditions, such as infections and conditions that affect the heart’s muscle, valves or beating rhythm, also are considered forms of heart disease. Relationship between Anxiety disorder and heart disease Anxiety and heart disease normally coexist and there are evidence to prove that anxiety disorder may be an independent risk factor that contribute to the development of heart diseases. Substantial epidemiological evidence implicates anxiety in the development of heart disease, as well as the occurrence of sudden cardiac death for both men and women. In an article published in the 1980 and 1998 showed the effect of anxiety on the pathogenesis of heart diseases. In a study, the effect of stress-induced atherosclerosis and endothelial dysfunction strongly supports the role of anxiety in the onset of coronary heart disease (Kubzansky and Kawachi 2000). In another study, researchers identified a link between anxiety and sudden cardiac death. People with anxiety showed reduced heart rate variability which may be pathological. This can lead to hypertension, ventricular arrhythmia, impaired vagal control and sympathetic stimulation which also has been link to the development of heart disease ((Rich et al., 1988; Sloan et al., 1999). Findings from retrospective epidemiological studies suggested that about one-fourth of individuals who died suddenly had experienced substantial emotional distress in the period immediately preceding their deaths (Lown, 1990). Epidemiological evidence about the influence of acute stress on a large number of sudden deaths suggested that acute emotional stress may precipitate cardiac events in people who are already predisposed to them (Leor et al., 1996). Furthermore, anxiety is a significant predictor of depression in both men and women with heart disease (Burker et al., 1995). According to a report published in the journal archive of psychiatry, anxiety increased the risk of getting heart disease and early death. The study was conducted with 1000 people with heart disease, there was a 74% increased risk of cardiovascular events in those with an anxiety disorder. The researchers studied the patient’s cohort for an average of five and half years. They found a 9.6% cardiovascular event in 102 of the patients. 24% to 31% of heart disease patient had symptoms of anxiety. A senior researcher with the Heart Research Centre, Alyna Turner in her independent study at the University of Newcastle found that patients with severe anxiety were more likely to be readmitted to hospital after a heart attack. In journal of American college of cardiology, 735 middle aged or elderly men who had good cardiovascular health in 1986 were studied, those who scored highest in four different anxiety test had a greater risk of developing heart attack later in life. 15% of the men who scored highest in any of the four test or combined, had 30% to 40% chance of getting heart attack than their peers who are less anxious. In another study by Annelieke M. Roest, MSc, of Tilburg University in the Netherlands, combined data from 20 studies on nearly 250,000 people. The average follow-up period was 11 years. The study identified a 26% increase risk of coronary heart disease and 48% increase risk in heart related death in people with anxiety. Imre Janszky, MD, PhD, of Karolinska Institutet in Stockholm, Sweden, also found that anxiety disorders are predictive of future heart disease even after controlling for other risk factors such as blood pressure and smoking.Anxiety more than doubled the subsequent risk of developing coronary blockages or having a heart attack. They examined data on 50,000 young Swedish men evaluated for military service between ages 18 and 20, with a follow-up of about 37 years. Conclusion Hypertension, coronary heart disease (CHD), and anxiety disorders all cause substantial morbidity to patients and costs to the healthcare system. Associations between these diseases have been hypothesized and studied for decades. In particular, psychosocial stressors associated with anxiety disorders raise autonomic arousal via the hypothalamic-pituitary axis which increases circulating catecholamines. This heightened arousal is associated with an increased risk of hypertension and a pro-inflammatory state and, consequently, development of coronary heart disease. This association holds across the spectrum of anxiety disorders (generalized anxiety, posttraumatic stress disorder, panic disorder, and obsessive compulsive disorder) and also when controlling for comorbid conditions such as depression and physical ailments. Multiple cross sectional studies reveal a positive association between anxiety and hypertension. These associations are bidirectional, with those with hypertension being more likely to have anxiety and those with anxiety being more likely to have hypertension. However, a few studies have shown no association. Longitudinal studies point to an increased risk of development of hypertension in patients who suffer from anxiety. References 1. Peter Crosta (23 July 2009). 2. Dr Ananya Mandal, MD. Medical research news. 3. Beyondblue anxiety and depression. 4. Wikipedia. 5. Mayor clinic 6. Laura Blue. A link between anxiety and heart attacks (Jan. 08, 2008) 7. Bill Hendrik. Anxiety may increase the risk of heart disease.(WebMD Health News) 8. Sandra K. Plach, Ph.D., R.N. Anxiety in women with heart disease. 9. Player MS and Peterson LE. Anxiety disorder, hypertension and cardiovascular risk
Posted on: Tue, 04 Mar 2014 22:37:19 +0000
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