Anxiety and cardiovascular disease: Epidemiology and proposed mechanisms

Anxiety disorders tend to be highly prevalent in heart disease, particularly amongst patients recovering from acute cardiac events. Yet, the role of anxiety in heart disease has not received as much attention in the literature as has depression. Epidemiologic studies indicate that there is an increased risk of sudden death and myocardial infarction in patients experiencing panic anxiety. Pathophysiologic correlates of anxiety appear to contribute to an increased cardiac risk, leading to the appreciation that anxiety disorders might in fact constitute a risk to life as exemplified by the cardiovascular disease link. Explanatory mechanisms of cardiac risk point to a link between anxiety and heart disease being mediated by stress giving way to increased cardiac sensitivity and reactivity. The present chapter reviews the psychobiological link between anxiety and heart disease. It also supports an integrative approach for the analysis of psychogenic heart disease, that cardiac patients can benefit from cardiologists educating them about the influence of psychosocial factors on their cardiac conditions and that further research is required on the development of specific psychologically based therapies which tap into the proposed pathophysiological mechanisms associated with the mind-heart nexus.