High levels of phobic anxiety have been associated with elevated risks of coronary heart disease ( CHD ), death and sudden cardiac death ( SCD ) among men – however no such association has been investigated among women.

Researchers at Brigham and Women’s Hospital ( BWH ) and Massachusetts General Hospital ( MGH ), in an analysis of data from the Nurses’ Health Study, found that women who experienced phobic anxiety, such as the fear of crowded places, heights or of going outside, were more likely to experience SCD or CHD than women who did not.

According to lead author Christine M. Albert, an epidemiologist at BWH and an electrophysiologist and cardiologist at MGH, “ Phobic anxiety is associated with coronary heart disease risk factors such as smoking, body weight and sedent ary behaviors. However, in this study, in which these risk factors were controlled, we found a correlation between higher levels of phobic anxiety and death from coronary heart disease, particularly from sudden cardiac death, despite these risk factors. In the past, there have been several studies that suggested that psychosocial factors, such as emotions, anxiety and anger have been associated with an elevated risk of heart disease; particularly, death from heart disease. This study furthers this knowledge and indicates that phobic anxiety may increase risk of coronary heart disease and sudden cardiac death in women.”

Researchers reviewed data from 72,359 women, age 30 to 55, who participated in the Nurse’s Health Study.
These women were free of cardiovascular disease and cancer in 1988 at the start of the prospective study. Participant’s level of phobic anxiety was measured - on a scale of one to 16 - by an eight-question questionnaire that focused on well-known symptoms related to phobic anxiety.

During the 12 years of follow-up, there were 97 sudden cardiac deaths, 267 coronary heart disease deaths and 930 non-fatal heart attacks.

Researchers found that women with higher levels of phobic anxiety who scored four or more on the scale were at an increased risk of dying suddenly from coronary heart disease compared to those in the lowest quarter of the population.

Specifically, women with a score greater than four had a 59 percent increased risk of sudden cardiac death and a 31 percent increased risk of fatal coronary heart disease, compared with those with a score of zero or one on the scale.
These risks were lower after controlling for other cardiac risk factors that are linked to phobic anxiety such as high blood pressure, diabetes and high cholesterol; however, even after controlling for these risks factors, a trend toward an increased risk for sudden cardiac death persisted.

The authors conclude that associations between anxiety and other cardiac risk factors might account for some, but not all, of the risk linked to phobic anxiety.

“ Researchers and clinicians still do not know all the risk factors and potential triggers of sudden cardiac death. These results, which closely mirror results found in men, point to one possible risk factor and should prompt physicians to be aware of this risk when treating patients with phobic disorders,” Albert said. “ Given our findings, physicians probably should consider that women who suffer from phobic anxieties are at elevated risk of death from heart disease and should, at the very least, try to control their other potential heart disease risk factors. Whether specific treatment for anxiety would have a positive impact on death from heart disease is unknown. This hypothesis could only be adequately tested in randomized trials.”

Phobic anxiety is twice as prevalent among women than men. It has been estimated that five percent of the population has anxiety disorders and as many as 15 percent will meet criteria for a phobic disorder.

The study has been published in Circulation, Journal of the American Heart Association.

Source: Brigham and Women’s Hospital, 2005


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