Phobic anxiety and increased risk of mortality in coronary heart disease.


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.





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Publication Info

Watkins, Lana L, James A Blumenthal, Michael A Babyak, Jonathan RT Davidson, Charles B McCants, Christopher O'Connor and Michael H Sketch (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

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Lana L. Watkins

Professor Emeritus in Psychiatry and Behavioral Sciences
  • Examination of the relationship between affective disorders and autonomic cardiovascular control.

    * Examination of the mechanisms underlying the increased cardiac mortality associated with anxiety disorders.

    * Examination of the role of behavioral factors (diet, exercise) as modulators of glycemic control and in the pathogenesis of cardiovascular autonomic neuropathy.

James Alan Blumenthal

J. P. Gibbons Distinguished Professor Emeritus of Psychiatry

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.


Michael Alan Babyak

Professor Emeritus in Psychiatry and Behavioral Sciences

Since coming to Duke as an intern in 1994 I have collaborated as a biostatistician and co-investigator at Duke on numerous observational and experimental studies involving behavior, psychosocial factors, health, and disease. The substantive topics have ranged across questions concerning exercise and depression, hypertension, weight loss, the genetics of stress and heart disease, sickle cell disease, to name a few. I am particularly interested in the issue of improving reproducibility and transparency in data analysis.

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 publications on treatment, epidemiology, health service utilization and quality of life in social phobia and PTSD, drug treatment of panic disorder. Magnetic resonance studies of social phobia have been completed and further studies are planned.


Christopher Michael O'Connor

Adjunct Professor in the Department of Medicine

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.


Michael Hugh Sketch

Professor of Medicine

My current research interests are focused in the area of diagnostic and interventional cardiac catheterization. In the arena of diagnostic cardiac catheterization, I am currently evaluating the role of Prostaglandin E1 in the prevention of contrast induced renal dysfunction. In the arena of interventional cardiac catheterization, I have been actively involved in both the development and subsequent determination of potential niches for new interventional technologies in the management of coronary artery disease. These interventional technologies include balloon angioplasty, the perfusion balloon catheter, transluminal extraction catheter, and several intracoronary stents.

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