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Are You Sitting Down?

By Eric Van De Graaff, MD July 12, 2010 Posted in: Heart Health

Now, whatever you do, don’t get too excited, anxious, worked-up, or fretful about this post.  It is, after all, only words on paper (or pixels on a computer screen, as the case may be).  Words cannot really hurt you—unless, of course, you’re hit on the head by a falling sign.  So, take a deep breath, relax and focus on your happy place.  Ready?  OK, here we go.

Two studies came out in this week’s issue of the Journal of the American College of Cardiology that link anxiety early in your life to heart disease later on.  The first was a meta-analysis of 20 studies among populations around the world that included the experience of nearly a quarter million individuals.  The authors were able to tease out of this large database a statistic that shows that anxious people are a quarter to a half more likely to suffer coronary disease or cardiac-related death than their calmer counterparts.

Even more compelling is a clever longitudinal evaluation of nearly 50 thousand young Swedish military conscripts reporting for duty between 1969 and 1970.  Each 18-to-20-year-old male was given a thorough physical and completed an exhaustive questionnaire.  If any of them gave answers that suggested any depression or anxiety (who could be anxious about joining the Swedish military in 1970?  It wasn’t exactly a hotbed of battlefield activity in those days.) they went on for a thorough evaluation by a psychiatrist.  Thanks to the magic of socialized medicine the researchers tracked the health course of all these individuals for 37 years and were able to determine who among them developed heart disease.  Among the cohort of enlistees with a clinical diagnosis of anxiety the risk of developing coronary disease in the ensuing decades was over two-fold higher.

On the surface you might object to the findings of these studies with the argument that inherently anxious people tend to smoke more and exercise less, but your objections wouldn’t hold.  Thanks to the large numbers in both of these studies the authors were able to factor in variables such as exercise and use of tobacco, and the relationship between anxiety and heart disease remained strong.

Possible explanations for the link between these two common disorders tend to all invoke the elevated level of catecholamines (adrenalin and noradrenalin) frequently demonstrated in jittery people and how these “fight or flight” hormones can have an insidious deleterious effect over time.

Anxiety itself is a bothersome enough problems without introducing yet another misery to accompany what is clearly a sometimes debilitating disorder.  Already, anxious people are afflicted with “considerable suffering, disability, and impaired quality of life,” according to the University of California, San Diego psychiatrist Joel E. Dimsdale, MD, in an accompanying editorial.  He goes on:

“The lifetime prevalence of anxiety disorders is approximately 28%.  Their impact on global functioning is roughly akin to that of low back pain or leg ulcers.  When anxiety coexists with depression, the corresponding impact on quality of life is even worse, along the lines of the impact of chronic obstructive pulmonary disease.”

The unknown factor in all of this is whether treatment for anxiety can ameliorate its long-term effect on coronary disease.  If you’re an emotionally wound-up nervous wreck but do your daily tai chi and yoga, eat all your healthy vegetables, take your prescribed anxiolytic medication, and become one with the universe, will you be able to cut your risk of heart disease back to the level of the rest of us calm people?  Or is your fate sealed the moment you are officially labeled with “anxiety disorder?”  We can’t know, and we may never know.  To figure this out we’d need to organize and fund a long-term controlled study comparing treatment to no treatment in thousands of anxious volunteers over the course of several decades—a prospect that no one is willing to take on.

So now, dear readers, if you’ve managed to stay calm throughout your perusal of this brief report, you’ve got nothing to worry about.  If, however, this revelation fills you with apprehension and dread then I offer you my sincerest apologies and take full responsibility for triggering anxiety and its lasting effects on your heart.  Schedule yourself an appointment with a cardiologist in, say, 20 or 30 years, then just sit back and try to relax.

Eric Van De Graaff, MD
Eric Van De Graaff, MD

Eric Van De Graaff, MD is a Heart & Vascular Specialist at CHI Health Clinic.

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