Anxiety and new onset of cardiovascular disease: critical review and meta-analysis

Br J Psychiatry. 2016 Mar;208(3):223-31. doi: 10.1192/bjp.bp.114.156554.


Background: Anxiety has been associated with new-onset cardiovascular disease (CVD), but the quality of this relationship is unclear. Only if anxiety is a causal, independent cardiovascular risk factor might it be a target for CVD prevention.

Aims: To determine and examine the independent association and causality between anxiety and incident CVD.

Method: PubMed, EMBASE and PsycINFO databases were searched up to October 2013. A review of Hill's criteria for causality and random effects meta-analysis were conducted of prospective, population-based studies examining anxiety and incident CVD in people free from CVD at baseline.

Results: The meta-analysis comprised 37 papers (n = 1 565 699). The follow-up ranged from 1 to 24 years. Anxiety was associated with a 52% increased incidence of CVD (hazard ratio = 1.52, 95% CI 1.36-1.71). The risk seemed independent of traditional risk factors and depression. The evaluation of Hill's criteria largely argued in favour of causality.

Conclusions: Anxiety may be of interest for CVD prevention. Future research should examine biological and behavioural underpinnings of the association in order to identify targets for intervention.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anxiety Disorders / epidemiology*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / psychology
  • Depressive Disorder / epidemiology*
  • Humans
  • Incidence
  • Risk Factors