The Anxious Heart in Whose Mind? a Systematic Review and Meta-regression of Factors Associated with Anxiety Disorder Diagnosis, Treatment and Morbidity Risk in Coronary Heart Disease

Abstract

Background

The association between anxiety disorders and verified coronary heart disease (CHD) remains to be clarified.

Objective

To report the prognostic association between anxiety disorder subtypes and subsequent major adverse cardiac events (MACE), report anxiety disorder prevalence in CHD, and the efficacy of randomized controlled trials (RCTs).

Methods

A comprehensive literature search was conducted for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE and RCTs. From 4,041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence), no RCTs were eligible.

Results

Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n = 2851). There was a non-significant association between GAD and MACE risk (Risk Ratio = 1.20, 95% CI .86 – 1.68, p = .28) however the effect size was highly significant in outpatient samples with adjustment for covariates (adjusted hazard ratio = 1.94, 95% CI 1.45 – 2.60, p <.001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28 – 64.01) and substantial heterogeneity between studies and anxiety disorder subtypes. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also significantly higher in DSM-III-R versus DSM-IV taxonomies (13.40% vs 3.43%, p <001; 11.12% vs. 6.80%, p <.001 respectively).

Conclusions

The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in the CHD population.