Anxiety Elevates Cardiometabolic Risk Over Time in US Men, Suggests New 40-year Study

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Middle-aged men in the US with anxiety may be at a greater risk for developing cardiometabolic disease later in life, according to a new long-term study published in the Journal of the American Heart Association.

“While the participants were primarily white men, our findings indicate 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 lead author Lewina Lee, PhD, assistant professor of psychiatry, Boston University School of Medicine, in an American Heart Association press release.

Previous research has linked anxiety to elevated risk of incident cardiometabolic disease, including coronary heart disease (CHD) and stroke, but the underlying mechanisms and trajectories of risk are unclear.

Lee and colleagues examined the prospective association of 2 anxiety facets—neuroticism and worry—with cardiometabolic risk (CMR) trajectories over a 40-year follow-up period. The team analyzed data from the Normative Aging Study— a longitudinal trial of aging processes in men.

The analysis included 1561 participants who in 1975 were free from cardiovascular disease or cancer and completed assessments of neuroticism and worry. At baseline, the analytic sample was 97% White and had an average age of 53 years.

After baseline, participants underwent physical exams and blood tests every 3 to 5 years until death, dropout, or the end of the study in 2015, according to the authors. During each follow-up visit, 7 cardiometabolic risk factors were measured: systolic blood pressure (BP), diastolic BP, total cholesterol, triglycerides, obesity as determined by body mass index, fasting blood glucose levels, and erythrocyte sedimentation rate.

High risk for each cardiometabolic factor was defined as exceeding the cut points from national guidelines or taking medication related to that factor. For erythrocyte sedimentation rate, for which there is no universal definition of high risk, those in the top quartile were considered high risk, according to researchers.

The investigators found that CMR increased at 0.8 markers per decade between ages 33 to 65 years, at which point participants had an average of 3.8 high‐risk markers, followed by a slower increase of 0.5 markers per decade.

Higher levels of neuroticism (B=0.08; 95% confidence interval [CI], 0.02-0.15) and worry (B=0.07; 95% CI, 0.001-0.13) were associated with elevated CMR across time, according to the results.

In addition, higher neuroticism and worry levels were associated with 13% (95% CI, 1.03-1.23) and 10% (95% CI, 1.01-1.20) greater risks, respectively, of having ≥6 high‐risk CMR markers, after researchers adjusted for demographics and family history of CHD.

“While we do not know whether treatment of anxiety and worry may lower one’s cardiometabolic risk, anxious and worry-prone individuals should pay greater attention to their cardiometabolic health,” said Lee in the press release. “For example, by having routine health check-ups and being proactive in managing their cardiometabolic disease risk levels (such as taking medications for high blood pressure and maintaining a healthy weight), they may be able to decrease their likelihood of developing cardiometabolic disease.”

“It would be important for future studies to evaluate if these associations exist among women, people from diverse racial and ethnic groups, and in more socioeconomically varying samples, and to consider how anxiety may relate to the development of cardiometabolic risk in much younger individuals than those in our study,” added Lee.