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Risk of Heart Attack, Death High Among Extremely Anxious Patients

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
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