Among healthy middle-aged men, those who were more anxious were more likely to develop high levels of multiple biomarkers of cardiometabolic risk over a 40-year follow-up in a new study.
“By middle adulthood, higher anxiety levels are associated with stable differences” in biomarkers of risk for coronary artery disease (CAD), stroke, and type 2 diabetes, which “are maintained into older ages,” the researchers write.
Anxious individuals “may experience deteriorations in cardiometabolic health earlier in life and remain on a stable trajectory of heightened risk into older ages,” they conclude.
The study, led by Lewina Lee, PhD, was published online January 24 in the Journal of the American Heart Association.
“Men who had higher levels of anxiety at the beginning of the study had consistently higher biological risk for cardiometabolic disease than less anxious men from midlife into old age,” Lee, assistant professor of psychiatry, Boston University School of Medicine, summarized in an email to theheart.org | Medscape Cardiology.
Clinicians may not screen for heart disease and diabetes, and/or only discuss lifestyle modifications when patients are older or have the first signs of disease, she added.
However, the study findings “suggest that worries and anxiety are associated with pre-clinical pathophysiological processes that tend to culminate in cardiometabolic disease” and show “the importance of screening for mental health difficulties, such as worries and anxiety, in men as early as in their 30s and 40s,” she stressed.
Since most of the men were White (97%) and veterans (94%), “it would be important for future studies to evaluate if these associations exist among women, people from diverse racial and ethnic groups, and in more socioeconomically varying samples, and to consider how anxiety may relate to the development of cardiometabolic risk in much younger individuals than those in our study,” Lee said in a press release from the American Heart Association.
“This study adds to the growing body of research that link psychological health to cardiovascular risk,” Glenn N. Levine, MD, who was not involved with this research, told theheart.org | Medscape Cardiology in an email.
“We know that factors such as depression and stress can increase cardiac risk; this study further supports that anxiety can as well,” added Levine, chief of cardiology, Michael E. DeBakey VA Medical Center, in Houston, Texas.
“Everyone experiences some anxiety in their life,” he added. However, “if a provider senses that a patient’s anxiety is far beyond the ‘normal’ that we all have from time to time, and it is seemingly adversely impacting both their psychological and physical health, it would be reasonable to suggest to the patient that it might be useful to speak with a mental health professional, and if the patient is receptive, to then make a formal consultation or referral,” said Levine, who was writing group chair of a recent AHA Scientific Statement on mind-heart-body connection.
Neuroticism and Worry
Several studies have linked anxiety to a greater risk of cardiometabolic disease onset, Lee and colleagues write, but it is unclear if anxious individuals have a steadily worsening risk as they age, or if they have a higher risk in middle age, which stays the same in older age.
To investigate this, they analyzed data from 1561 men who were seen at the VA Boston outpatient clinic and did not have CAD, type 2 diabetes, stroke, or cancer when they enrolled in the Normative Aging Study.
The men had a mean age of 53 years (range, 33 to 84) in 1975 and were followed until 2015 or until dropout from the study or death.
At baseline, the study participants filled in the Eysenck Personality Inventory, which assesses neuroticism, and also responded to a scale indicating how much they worry about 20 issues (excluding health).
“Neuroticism,” the researchers explain, “is a tendency to perceive experiences as threatening, feel that challenges are uncontrollable, and experience frequent and disproportionately intense negative emotions,” such as fear, anxiety, sadness, and anger, “across many situations.”
“Worry refers to attempts to solve a problem where future outcome is uncertain and potentially positive or negative,” Lee noted. Although worry can be healthy and lead to constructive solutions, “it may be unhealthy, especially when it becomes uncontrollable and interferes with day-to-day functioning.”
Of note, in 1980, the American Psychiatric Association removed the term neurosis from its diagnostic manual. What was previously called neurosis is included as part of generalized anxiety disorder (GAD). GAD also encompasses excessive worry.
Cardiometabolic Risk From Midlife to Old Age
The men in the current study had on-site physical examinations every 3 to 5 years.
The researchers calculated the men’s cardiometabolic risk score (from 0 to 7) by assigning 1 point each for the following: systolic blood pressure >130 mm Hg, diastolic blood pressure >85 mm Hg, total cholesterol ≥240 mg/dL, triglycerides ≥150 mg/dL, body mass index ≥30 kg/m2, glucose ≥100 mg/dL, and erythrocyte sedimentation rate (ESR, a marker of inflammation) ≥14 mm/hour.
Alternatively, patients were assigned a point each for taking medication that could affect these markers (except for body mass index).
Overall, on average, at baseline, the men had a cardiometabolic risk score of 2.9. From age 33 to 65, this score increased to 3.8, and then it did not increase as much later on.
That is, the cardiometabolic risk score increased by 0.8 per decade until age 65, followed by a slower increase of 0.5 per decade.
At all ages, men with higher levels of neuroticism or worry had a higher cardiometabolic risk score
Each additional standard deviation of neuroticism was associated with a 13% increased risk of having six or more of these seven cardiometabolic risk markers during follow-up, after adjusting for age, demographics, and family history of CAD, but the relationship was attenuated after also adjusting for health behaviors (eg, smoking, alcohol consumption, physical activity, and past-year physician visit at baseline).
Similarly, each additional standard deviation of worry was associated with a 10% increased risk of having six or more of these seven cardiometabolic risk markers during follow-up after the same adjustments, and was also no longer significantly different after the same further adjustments.
The research was supported by grants from the National Institutes of Health and a Senior Research Career Scientist Award from the Office of Research and Development, US Department of Veterans Affairs. The Normative Aging Study is a research component of the Massachusetts Veterans Epidemiology Research and Information Center and is supported by the VA Cooperative Studies Program/Epidemiological Research Centers. The study authors and Levine have disclosed no relevant financial relationships.
J Am Heart Assoc. Published online January 24, 2022. Full text
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