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"There is an independent contribution of anxiety that can predict the onset of a heart attack among healthy older men," said lead researcher Biing-Jiun Shen, an assistant professor of psychology at the University of Southern California in Los Angeles.
Even after accounting for anger, hostility, depression and type A personality, anxiety still predicted the onset of a heart attack, Shen said. "The relationship between anxiety and heart attack cannot be explained by depression, hostility or type A personality," he said.
In the study, Shen's group collected data on 735 men who participated in the Normative Aging Study, which assesses medical and psychological changes associated with aging. Each of the men completed psychological testing in 1986 and had no heart problems at the time. The men were followed for an average of 12 years.
The report appears in the Jan. 15 issue of the Journal of the American College of Cardiology.
During follow-up, the researchers found men who had chronic anxiety had a 30 percent to 40 percent increased risk of heart attack. Those with the highest levels of anxiety on psychological testing had an even higher risk of heart attack.
The risk posed by anxiety remained even after the researchers adjusted their data to account for standard cardiovascular risk factors, health habits, and negative psychological and personality traits, Shen said.
Whether treating anxiety reduces the risk of heart attack isn't known, Shen said. "But the implication is there," he added. "It is something that doctors can look out for."
Shen's team is hoping to study that possibility. "Hopefully, that will reduce the risk for heart disease," he said.
In addition, it isn't known if women are also at risk for heart attack from chronic anxiety, Shen noted.
One expert agreed that psychological factors play a significant role in the risk for having a heart attack.
"Psychological characteristics including anxiety, anger, hostility and type A personalities have been associated with increased risk of heart attack in a number of prior studies, and this study again shows that chronic anxiety appears to raise an individual's heart attack risk," said Dr. Gregg C. Fonarow, a cardiology professor at the University of California, Los Angeles.
"An important finding of this study is that anxiety not only represents an independent risk factor for heart attack but may also explain the associations between heart attack risk with other psychosocial risk factors," Fonarow said.
Exaggerated response to acute and chronic stress in anxious individuals may trigger a number of pathways which increase the risk of developing coronary artery disease and being stricken with a heart attack, Fonarow said.
"Highly anxious individuals should be aware they may face an increased risk of a heart attack and take proactive steps under physician supervision to control those cardiovascular risk factors which are modifiable including blood pressure, lipid levels, activity level and weight," Fonarow added.
SOURCES: Biing-Jiun Shen, Ph.D., assistant professor, psychology, University of Southern California, Los Angeles; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Jan. 15, 2008, Journal of the American College of Cardiology
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