Alzheimer's, Dementia & Mental Health
Study is First Linking Stroke Directly to Anxiety;
Earlier Study Finds It Deadly for Heart Patients
In older adults, anxiety disorders often occur at the
same time as depression, heart disease, diabetes, and other medical
Dec. 27, 2013 – Congratulations, you have survived
the period of peak anxiety during this holiday season. The greater your
anxiety level, the higher your risk of having a
stroke, according to
new research published in the American Heart Association journal
Stroke. And, heart disease patients who suffer
anxiety have twice
the risk of dying.
Heart patients with both anxiety and
triple the risk of dying, researchers said, in the
Journal of the American
published earlier this year.
stroke study is
reported to be the first in which researchers linked
stroke independent of other factors such as depression. Anxiety
disorders are one of the most prevalent mental health problems. Symptoms
include feeling unusually worried, stressed, nervous or tense.
Over a 22 year period, researchers studied a
nationally representative group of 6,019 people 25-74 years old in the
first National Health and Nutrition Examination Survey (NHANES I).
Participants underwent an interview and took blood
tests, medical examinations and completed psychological questionnaires
to gauge anxiety and depression levels.
Researchers tracked strokes through hospital or
nursing home reports and death certificates. After accounting for other
factors, they found that even modest increases in anxiety were
associated with greater stroke risk.
People in the highest third of anxiety symptoms had
a 33 percent higher stroke risk than those with the lowest levels.
“Everyone has some anxiety now and then. But when
it’s elevated and/or chronic, it may have an effect on your vasculature
years down the road,” said Maya Lambiase, Ph.D., study author and
cardiovascular behavioral medicine researcher in the Department of
Psychiatry at the University of Pittsburgh School of Medicine, in
and Senior Citizens
Doctors and older adults tend to view
anxiety and fear as normal given the circumstances of aging. But
developing an anxiety disorder late in life is not a normal part
of aging, according to
NIH Senior Health.
Studies estimate that anxiety disorders
affect between 3 and 14 percent of older adults in a given year.
More women than men experience anxiety disorders. They tend to
be less common among older adults than younger adults.
Anxiety caused by stressful events like
moving or losing a job is a normal part of life. But anxiety
disorders are different. An anxiety disorder lasts a long time
and can get worse if it is not treated.
Anxiety disorders commonly occur at the
same time as other illnesses. In older adults, anxiety disorders
often occur at the same time as depression, heart disease,
diabetes, and other medical problems.
In some cases, these other illnesses need
to be treated before a person will respond to treatment for the
National Institute of Mental Health says you may feel
anxious before you take a test or walk down a dark street. This
kind of anxiety is useful - it can make you more alert or
careful. It usually ends soon after you are out of the situation
that caused it.
But for millions of people
in the United States, the anxiety does not go away, and gets
worse over time. They may have chest pains or nightmares. They
may even be afraid to leave home. These people have anxiety
disorders. Types include:
Post-traumatic stress disorder
• Generalized anxiety disorder
People with high anxiety levels are more likely to
smoke and be physically inactive, possibly explaining part of the
anxiety-stroke link. Higher stress hormone levels, heart rate or blood
pressure could also be factors, Lambiase said.
In earlier work, researchers found that depression
was linked to greater risk of stroke. In contrast to anxiety, depression
is a persistent feeling of hopelessness, dejection, and lack of energy,
among other symptoms.
Stroke is the No. 4 killer and a leading cause of
disability in the United States, according to this study funded by the
National Heart, Lung, and Blood Institute and the National Institute of
Anxiety, depression identify heart disease
patients at increased risk of dying
“Many studies have linked depression to an
increased risk of death in heart disease patients,” said Lana Watkins,
Ph.D., lead author of the study and an associate professor in Psychiatry
and Behavioral Sciences at Duke University Medical Center in Durham,
N.C. “However, anxiety hasn’t received as much attention.”
Studies show that depression is about three times
more common in heart attack patients. The American Heart Association
recommends that heart patients be screened for depression and treated if
Depressed heart disease patients often also have
anxiety, suggesting it may underlie the risk previously attributed
solely to depression, Watkins said. “It’s now time for anxiety to be
considered as important as depression, and for it to be examined
In the study, 934 heart disease patients, average
age 62, completed a questionnaire measuring their level of anxiety and
depression immediately before or after a cardiac catheterization
procedure at Duke University Medical Center. Patients had anxiety if
they scored 8 or higher on a scale composed of seven common
characteristics of anxiety, with each item rated from 0 to 3 (range of
possible scores: 0-21). Depression was measured using a similar scale
composed of seven symptoms of depression.
Researchers, after accounting for age, congestive
heart failure, kidney disease and other factors that affect death risk,
• 90 of the 934 patients experienced anxiety
only, 65 experienced depression only and 99 suffered anxiety and
• Among 133 patients who died during three years
of follow-up, 55 had anxiety, depression or both. The majority of deaths
(93 of 133) were heart-related.
Researchers measured anxiety and depression during
cardiac catheterization because levels better reflected how patients
normally handle stressful situations.
Anxiety and depression each influence risk of death
in unique ways. Anxiety, for example, increases activity of the
sympathetic (adrenaline-producing) nervous system that controls blood
“People who worry a lot are more likely to have
difficulty sleeping and to develop high blood pressure,” Watkins said.
The link between depression and mortality is more
related to behavioral risk factors, she said. “Depression results in
lack of adherence to medical advice and treatments, along with behaviors
like smoking and being sedentary.”
Future studies should test strategies to manage
anxiety alone and with depression in heart disease patients, Watkins
“Anxiety reducing medications combined with stress
management could improve outcome for patients with just anxiety, whereas
patients with anxiety and depression may need a stronger intervention
involving more frequent outpatient monitoring and incentives to improve
adherence,” she said.
Co-authors are: Gary G. Koch, Ph.D.; Andrew
Sherwood, Ph.D.; James A. Blumenthal, Ph.D.; Jonathan R.T. Davidson,
M.D.; Christopher O’Connor, M.D.; and Michael H. Sketch Jr., M.D. Author
disclosures are on the manuscript.
The National Institutes of Health funded this
>>For more information about the role anxiety and
depression play in heart disease, visit
depression screening in
>> For the latest heart and stroke news, follow us
>>For stroke science, follow the Stroke journal at
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