Phobic anxiety and increased risk of mortality in coronary heart disease.
Abstract
OBJECTIVES: To evaluate whether phobic anxiety is associated with increased risk of
cardiac mortality in individuals with established coronary heart disease (CHD) and
to examine the role of reduced heart rate variability (HRV) in mediating this risk.
Previous findings suggest that phobic anxiety may pose increased risk of cardiac mortality
in medically healthy cohorts. METHODS: We performed a prospective cohort study in
947 CHD patients recruited during hospitalization for coronary angiography. At baseline,
supine recordings of heart rate for HRV were collected, and participants completed
the Crown-Crisp phobic anxiety scale. Fatal cardiac events were identified over an
average period of 3 years. RESULTS: Female CHD patients reported significantly elevated
levels of phobic anxiety when compared with male patients (p < .001), and survival
analysis showed an interaction between gender and phobic anxiety in the prediction
of cardiac mortality (p = .058) and sudden cardiac death (p = .03). In women, phobic
anxiety was associated with a 1.6-fold increased risk of cardiac mortality (hazard
ratio, 1.56; 95% confidence interval, 1.15-2.11; p = .004) and a 2.0-fold increased
risk of sudden cardiac death (hazard ratio, 2.02; 95% confidence interval, 1.16-3.52;
p = .01) and was unassociated with increased mortality risk in men (p = .56). Phobic
anxiety was weakly associated with reduced high-frequency HRV in female patients (r
= -.14, p = .02), but reduced HRV did not alter the association between phobic anxiety
on mortality. CONCLUSIONS: Phobic anxiety levels are high in women with CHD and may
be a risk factor for cardiac-related mortality in women diagnosed with CHD. Reduced
HRV measured during rest does not seem to mediate phobic anxiety-related risk.
Type
Journal articleSubject
AdultAged
Aged, 80 and over
Blood Pressure
Blood Pressure Determination
Cohort Studies
Comorbidity
Coronary Disease
Death, Sudden, Cardiac
Female
Heart Rate
Humans
Male
Middle Aged
Myocardial Infarction
Phobic Disorders
Proportional Hazards Models
Prospective Studies
Rest
Risk Factors
Sex Factors
Survival Analysis
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https://hdl.handle.net/10161/13056Published Version (Please cite this version)
10.1097/PSY.0b013e3181e9f357Publication Info
Babyak, MA; Blumenthal, James Alan; Davidson, Jonathan RT; McCants, CB; O'Connor,
Christopher Michael; Sketch, MH; & Watkins, LL (2010). Phobic anxiety and increased risk of mortality in coronary heart disease. Psychosom Med, 72(7). pp. 664-671. 10.1097/PSY.0b013e3181e9f357. Retrieved from https://hdl.handle.net/10161/13056.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
James Alan Blumenthal
J. P. Gibbons Professor of Psychiatry I
Psychosocial factors and coronary heart disease, including such factors as social
support, Type A behavior and hostility, and depression, exercise training and depression
in the elderly; behavioral approaches to the treatment of hypertension (e.g., weight
loss and exercise); cardiac rehabilitation; neuropsychological outcomes following
cardiac surgery; psychosocial aspects of heart and lung transplantation; exercise
training and osteoarthritis and fibromyalgia; compliance.
Jonathan R.T. Davidson
Professor Emeritus of Psychiatry and Behavioral Sciences
Currently, my research focuses upon the theoretical aspects of homeopathy and its
clinical utilization, as well as the broader field of alternative (complementary)
medicine. this is a field which has traditionally been overlooked as a legitimate
scientific discipline. Other areas of activity are as in the past, i.e., clinical
treatment, epidemiology, risk factors, pathogenesis of posttraumatic stress, social
phobia, other anxiety status, and depression. These are illustrated by recent pu
Christopher Michael O'Connor
Richard Sean Stack, M.D. / Guidant Foundation Professor of Cardiology
Dr. O’Connor’s research interests include: acute heart failure; co-morbidities in
heart failure; clinical trials; biomarkers; and novel pharmacological and non-pharmacological
approaches for the treatment of heart failure.
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