Worrying more may raise heart disease risk in men

Anxiety is linked to several cardiometabolic conditions, including coronary heart disease, stroke, diabetes, and hypertension. The reasons behind these links and how they develop, however, remain unclear. 

Some studies have shown that people who are anxious develop increased cardiometabolic risk factors, such as a steeper rise in body mass index (BMI), as they age. 

Other research suggests that deterioration in cardiometabolic health occurs relatively early in the life of anxious individuals and that this lasts into older age. 

Establishing how exactly this link works is difficult, as few cohort studies have recorded longitudinal data on anxiety alongside a broad range of cardiometabolic outcomes. 

In a recent study, researchers at the Boston University School of Medicine led a team of scientists investigating the link between cardiometabolic outcomes and indicators of anxiety. 

“Our findings indicate [that] higher levels of anxiousness or worry among men are linked to biological processes that may give rise to heart disease and metabolic conditions, and these associations may be present much earlier in life than is commonly appreciated — potentially during childhood or young adulthood,” said Lewina Lee, Ph.D., lead author of the study and assistant professor of psychiatry at Boston University School of Medicine. 

The study was published in the Journal of the American Heart Association (JAHA). 

Data analysis

The researchers obtained data from the Normative Aging Study, which the Department of Veterans Affairs established in the 1960s. 

They selected a sample of 1,561 individuals from an ongoing adult male cohort. Each person had submitted assessments of seven cardiometabolic biomarkers every 3–5 years since 1975. These included: 

• systolic and diastolic blood pressure as indicators of hypertension
• fasting triglycerides as an indicator of dyslipidemia, meaning unhealthy levels of fat in the blood
• fasting total cholesterol as an indicator of high cholesterol 
• BMI as an indicator of obesity 
• fasting glucose as an indicator of high blood glucose 
• erythrocyte sedimentation rate (ESR) as an indicator of inflammation

Alongside cardiometabolic biomarkers, all participants completed a nine-item questionnaire based on the Eysenck Personality Inventory at the start of the study alongside a 20-item questionnaire asking how much they worry about various issues on a scale of 0 to 4.

Although the Eysenck Personality Inventory is not a standard test for anxiety, it assesses for neuroticism, which refers to sensitivity to negative emotion. Experts consider neuroticism a causal factor for anxiety disorders and see worry as a major facet of anxiety and a coping method to prepare for future threats. 

The researchers also obtained demographic information from the participants, including: 

• age 
• race 
• socioeconomic status based on father’s profession
• marital status
• family history of congenital heart defects (CHD)
• current smoking status
• exercise levels 
• alcohol consumption 

At the beginning of the study, the average age of the participants was 53 years. Between 1975 and 2015, they underwent an average of 6.6 cardiometabolic examinations. In the same period, 1,067 individuals died. 

The researchers noted that higher neuroticism levels were linked to fewer years of education, a higher degree of CHD family history, lower socioeconomic status, and higher levels of smoking and drinking. 

After analyzing the data, they found that the participants who scored higher in neuroticism had a greater number of high risk cardiometabolic risk factors at all ages. 

After adjusting for demographic factors, the scientists found that higher neuroticism was linked to a 13% higher chance of having six or more cardiometabolic disease risk factors. 

They also found an association between higher worry levels and a 10% higher risk of having six or more cardiometabolic disease risk factors. 

Altogether, they say that the effects of neuroticism and worry on cardiometabolic health are similar to those of long-term heavy drinking.