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Is Health Anxiety A Risk Factor For Heart Disease?

It has been known that people who have sedentary lifestyle, diabetes, high blood cholesterol, high blood pressure, or are overweight or obese are at a higher risk of getting heart disease. Research also shows that anxiety disorders generally may help trigger or worsen cardiovascular disease. An estimate 40 million people in the United States have an anxiety disorder, according to the Anxiety and Depression Association of America (ADAA). Despite of the fact that anxiety is highly treatable, about two-thirds of these people do not receive proper treatment.

A recent study, however, found that healthy people who have health anxiety may be linked to development of heart disease, too. Health anxiety, sometimes called hypochondria, is a condition characterized by a persistent preoccupation with having or developing a serious health problem and seeking medical help in the absence of any physical illness.

People with health anxiety may constantly seek information and reassurance, for example, obsessively researching information on illnesses, or having frequent tests that do not find any problem. On the other extreme, they may have avoidant behavior like avoiding medical TV programs, GP appointments and anything else that might trigger the anxiety. Such permanent anxiety may push them to a point where it can cause great distress and affects their everyday life.

The study, which was published online November 3, 2016 in journal ‘BMJ Open’, reported that healthy people who have signs of health anxiety were twice as likely to develop heart disease than those who showed no signs, and the higher the reported anxiety, the higher the risk of heart disease.

Researchers from the division of psychiatry at Sandviken University hospital and other institutions in Bergen, Norway analyzed 7,052 participants in the long-term collaborative research project Norwegian Hordaland health study (HUSK), all of whom were born between 1953 and 1957. To identify cases, researchers linked the participants with the Cardiovascular Diseases in Norway (CVDNOR) study that collected data on all hospitalizations and deaths due to cardiovascular disease in Norway from 1994 to 2009.

Between 1997 and 1999, the participants filled in questionnaires about their health, lifestyle and educational attainment and had a physical checkup. Levels of health anxiety were assessed using a widely-used self-report scale, the Whitley Index. The top 10 percent of the sample, 710 people, were considered to have health anxiety. Heart health of all the participants was tracked up to the end of 2009. Anyone who received treatment for, or whose death was linked to, coronary artery disease occurring within a year of entering the study, was excluded on the grounds that they might already have been ill.

Overall, 234 (3.3 percent) of the entire sample had an ischemic event, like having a heart attack or session of acute angina, during the monitoring period. The proportion of those developing heart disease was twice as high (6.1 percent) among those who had health anxiety compared with those who had not (3 percent). After taking account of other established cardiovascular risk factors, those with health anxiety at the start of the study were found to be 73 percent more likely to develop heart disease than those who did not have anxiety at the outset.

Since the study was observational, it could not conclude that health anxiety directly and independently raises the risk of developing heart disease. Other mental health issues may co-exist with health anxiety also making it difficult to differentiate. Furthermore, the findings may be less applicable elsewhere as there may be differences in lifestyle and environment between Norway and other countries.

According to some experts, it is possible that health anxiety may indirectly raise heart disease risk. Anxiety and stress can trigger unhealthy habits such as smoking or eating badly and they may spend less time exercising. All these may put them at greater risk of heart disease.

While the connection between healthy anxiety and heart disease seems fairly strong, doctors may find it difficult to tell patients with health anxiety about the risk of unduly worry without worsening their anxiety. Perhaps the best solution might be that doctors encourage patients to seek treatment for their health-related anxiety while still reaffirming the role anxiety can play in their physical health.




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