Anxiety Disorder as an Independent Risk Factor For Coronary Heart Disease: A Systematic Review and Meta-Analysis

Document Type

Conference Proceeding

Publication Date

11-4-2025

Publication Title

Circulation

Abstract

Background: Anxiety disorders are common, but their role in cardiovascular risk is underrecognized. Traditional risk factors for coronary heart disease (CHD), such as hypertension and diabetes, are well established, but anxiety may independently influence future heart disease. Emerging evidence suggests anxiety can predict events such as myocardial infarction. We aimed to quantify the association between anxiety disorders and the risk of developing CHD in adults without prior heart disease. Hypothesis and Objectives: We hypothesized that anxiety disorders increase CHD incidence and aimed to determine whether anxiety is an independent risk factor for heart disease. We also examined anxiety subtypes such as generalized anxiety disorder (GAD) and post-traumatic stress disorder (PTSD) for differential associations with CHD. Methods: We conducted a systematic review and meta-analysis. We searched MEDLINE, Scopus, Embase, and Google Scholar for English-language studies from 2010 to 2023. Eligible studies included adults with anxiety (diagnosed by standardized criteria) and measured incident CHD outcomes in individuals free of CHD at baseline. Two reviewers independently extracted data. A random-effects meta-analysis estimated pooled hazard ratios with 95% confidence intervals; heterogeneity was assessed by I2 statistic. Results: A total of ten studies (n=546,802) met inclusion criteria. The pooled hazard ratio for incident CHD (primarily myocardial infarction) in participants with anxiety versus without anxiety was 1.35 with a 95% confidence interval of 1.20–1.52 (p< 0.001), indicating a significant association. Subgroup analysis identified generalized anxiety disorder and post-traumatic stress disorder as anxiety subtypes most strongly linked to higher CHD risk. Statistical heterogeneity was moderate (I2=39%, p=0.11). Most studies adjusted for traditional cardiovascular risk factors. Conclusions: These findings provide strong evidence that anxiety disorders, particularly GAD and PTSD, are independently associated with higher CHD risk. Integrating mental health assessment with cardiovascular prevention could help identify modifiable risk factors. We conclude that addressing anxiety may be important in CHD prevention strategies.

Volume

152

Issue

Suppl 3

First Page

A4361293

Comments

American Heart Association's 2025 Scientific Sessions and the American Heart Association's 2025 Resuscitation Science Symposium, November 7-10, 2025, New Orleans, LA

Last Page

A4361293

DOI

10.1161/circ.152.suppl_3.4361293

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