Those Who Find Inner Calm Live Longer, Healthier Lives
Worried sick: We’ve all heard the phrase, but now there’s new evidence that might really knit your brow. New research shows that highly anxious patients with heart disease face nearly double the risk of heart attack or death when compared to those with a more serene outlook on life.
Patients whose anxiety intensified over time were in greatest peril, while those who started out highly anxious but later found inner calm markedly reduced their risk.
“Most patients come in very anxious about their coronary condition,” said Charles M. Blatt, M.D., F.A.C.C., director of research at the Lown Cardiovascular Research Foundation and a clinical professor of medicine at Harvard Medical School, both in Boston. “I’m convinced that spending time with the patient and the family and interacting with them as a caring human being is critically important to clinical outcomes.”
Previous studies have shown that mental stress and depression have harmful effects on the heart and blood vessels, but until now there has been little information on the corrosive effects of anxiety or the benefits of relieving anxiety over time.
For the study, Dr. Blatt and his colleagues recruited 516 patients with proven coronary artery disease. At the beginning of the study and again each year patients completed a standardized questionnaire about their feelings during the previous week, for example, whether they felt peaceful, felt something bad would happen, took a long time to fall asleep at night, or had upset bowels or stomach.
Those with anxiety scores in the highest third had nearly double the risk of heart attack or death when compared to those with anxiety scores in the lowest third (hazard ratio, 1.97; p=0.04). Looked at from another angle, the data showed a 6 percent increase in the risk of death or heart attack each time the average cumulative anxiety scored notched up by 1 unit (p=0.02).
The initial anxiety score alone offered little clue to the patient’s future health. However, an increase in anxiety over time hiked the risk of heart attack or death by 10 percent.
J Am Coll Cardiol, 2007; 49:2021-2027, doi:10.1016/j.jacc.2007.03.007 (Published online 3 May 2007).
Anxiety Worsens Prognosis in Patients With Coronary Artery Disease
Woldecherkos A. Shibeshi, MD, Yinong Young-Xu, ScD, MS, MACharles M. Blatt, MD, FACC
Manuscript received September 19, 2006; revised manuscript received January 19, 2007, accepted February 5, 2007.
Objectives: This study examined the effect of anxiety on mortality and nonfatal myocardial infarction (MI) in patients with coronary artery disease (CAD).
Background: Inconsistent data exist regarding the impact of anxiety on the prognosis of patients with CAD.
Methods: The authors conducted a prospective cohort study at an outpatient cardiology clinic of 516 patients with CAD (mean age 68 years at entry, 82% male) by administering the Kellner Symptom Questionnaire annually. The primary outcome was the composite of nonfatal MI or all-cause mortality.
Results: During an average follow-up of 3.4 years, we documented 44 nonfatal MIs and 19 deaths. A high cumulative anxiety score was associated with an increased risk of nonfatal MI or death. Comparing the highest to lowest tertile of anxiety score, the age-adjusted hazard ratio was 1.97 (95% confidence interval 1.03 to 3.78, p = 0.04). In a multivariate Cox model after adjusting for age, gender, education, marital status, smoking, hypertension, diabetes mellitus, previous MI, body mass index, and total cholesterol, each unit increase in the cumulative mean anxiety score was associated with increased risk of nonfatal MI or total mortality; the hazard ratio was 1.06 (95% confidence interval 1.01 to 1.12, p = 0.02).
Conclusions: A high level of anxiety maintained after CAD diagnosis constitutes a strong risk of MI or death among patients with CAD.
|Abbreviations and Acronyms|
|CAD = coronary artery disease|
|CI = confidence interval|
|HR = hazard ratio|
|MI = myocardial infarction|
|SQ = The Kellner Symptom Questionnaire|