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Risk of Heart Attack, Death High Among Extremely Anxious Patients

A new research has found that extremely anxious patients with heart disease are at double the risk of heart attack or death when compared to those with a calmer attitude on life.

Patients whose anguish strengthened over time were in greatest danger, while those who initially had high anxiety levels but later found inner calm noticeably reduced their risk.

"Most patients come in very anxious about their coronary condition. Im convinced that spending time with the patient and the family and interacting with them as a caring human being is critically important to clinical outcomes," said Charles M. Blatt, M.D., F.A.C.C., director of research at the Lown Cardiovascular Research Foundation and a clinical professor of medicine at Harvard Medical School, both in Boston.

Earlier studies have shown that mental strain and depression have harsh effects on the heart and blood vessels, but until now there has been little information on the cutting effects of anxiety or the advantages of lessening anxiety in due course.

For the study, Dr. Blatt and his colleagues recruited 516 patients with confirmed coronary artery disease. At the commencement of the study and again each year patients completed a uniform questionnaire about their feelings during the previous week, for example, whether they felt calm, felt something bad would happen, took a long time to fall asleep at night, or had upset bowels or stomach.

Patients were followed-up for an average of more than 3 years. During that time, 19 patients died and 44 had a nonfatal heart attack. Cumulative anxiety scores were averaged and adjusted for age, and the patients were divided into 3 groups. Those with anxiety scores in the highest third had almost double the risk of heart attack or death when compared to those with anxiety scores in the lowest third. Looked at from another angle, the data showed a 6 percent increase in the risk of death or heart attack each time the average cumulative anxiety scored notched up by 1 unit.

The initial anxiety score alone offered minute clues to the patients future health. However, an increase in anxiety eventually hiked the risk of heart attack or death by 10 percent. On the contrary, patients whose anxiety level was in the highest third at baseline, but in the lowest third when cumulative average anxiety levels were tallied, were among the least likely to have a heart attack or to die.

The results show not only the need for repetitive measurements to precisely estimate the impact of anxiety but also suggests a significant role for physicians in encouraging anxious patients, Dr. Blatt said.

Spending extra time with patients and families gives the cardiologist a chance to talk about heart disease, adjust medications, persuade exercise, and come up with effective strategies to advance cardiac risk factors, such as smoking, high cholesterol and high blood pressure. Equally important, it helps to set up a caring relationship that lightens the fears that could shorten a patients life.

"I tell patients well-managed coronary disease is consistent with a long happy life. If you give people this type of reassurance, it turns a frightening disease into something they can grow old with," Dr. Blatt said.

"This study provides further insight into the complex connections between the brain and heart. Appropriately, cardiologists have traditionally focused their therapeutic efforts on factors known to influence long-term outcome in coronary disease, such as making sure to aggressively lower LDL cholesterol. The results of this study demonstrate that we may need to consider more thoroughly evaluating patients with mood disorders such as anxiety, as treatment may very well reduce the risk of heart disease," said Dr. James L. Januzzi, M.D., F.A.C.C. and an associate professor of medicine at Harvard Medical School and director of the car diac intensive care unit at Massachusetts General Hospital, Boston.

Now that research has documented the harmful effects of anxiety, the next step is to find out the most effective ways of both reducing anxiety and improving cardiac health. Anti-anxiety medications and psychotherapy will be evaluated in the next stage of the study, but Dr. Blatt and his colleagues will also be examining the doctor-patient relationship.

"My hunch is that for the majority of patients, the greatest anxiety-reducing effect comes from having a good relationship with a doctor," Dr Blatt said.


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