a School of Psychology , University of Adelaide , Adelaide , Australia .
Psychol Health Med. 2013;18(6):627-44. doi: 10.1080/13548506.2012.749355. Epub 2013 Jan 16.
The aims of this review article are to present psychophysiological and behavioral pathways for the involvement of worry and generalized anxiety disorder (GAD) upon cardiovascular function. The review will focus on persons with and without coronary heart disease (CHD), and encompass etiological and prognostic studies.
Articles (1975-2011) reporting on GAD or worry affecting CHD prognosis or cardiovascular function were found using MEDLINE, EMBASE, SCOPUS and PsychINFO database searches, and extracted to form a narrative review.
Available evidence in experimental and observational studies in CHD free samples consistently showed that worry was associated with diminished heart rate variability (HRV) and elevated heart rate. Worry and GAD were commonly associated with blood pressure and diagnosed hypertension or medication use in both disease-free and established CHD populations. No evidence was found to support worry being beneficial to cardiovascular function or conducive to health promoting behaviors. The literature indicated that measures of worry were associated with fatal and nonfatal CHD in seven etiological studies of initially disease-free individuals; however, females were underrepresented. Three studies reported that GAD was associated with poorer prognosis in establish CHD, independent of depression. The median GAD prevalence was 10.4% in 3266 patients across 15 studies, suggesting that GAD is marginally less common in CHD samples than is depression.
A growing literature highlights the association between worry and development of CHD. The association between worry, GAD and CHD risk factors (e.g. blood pressure), and HRV are leading mechanisms of cardiopathogenesis that may affect cardiovascular function. Findings regarding worry and GAD in established CHD are less clear.
本文旨在介绍涉及焦虑和广泛性焦虑障碍（GAD）对心血管功能影响的心理生理和行为途径。综述将聚焦于有无冠心病（CHD）的人群，并包括病因学和预后研究。
使用 MEDLINE、EMBASE、SCOPUS 和 PsychINFO 数据库搜索，查找报告 GAD 或担忧影响 CHD 预后或心血管功能的文章（1975-2011 年），并提取形成叙述性综述。
在无 CHD 样本的实验和观察性研究中，现有的证据表明，担忧与心率变异性（HRV）降低和心率升高有关。在无疾病和已确诊 CHD 人群中，担忧和 GAD 通常与血压和诊断高血压或药物使用有关。没有证据表明担忧对心血管功能有益或有利于促进健康的行为。文献表明，在最初无疾病的个体中进行的 7 项病因学研究中，有 6 项研究表明担忧与致命和非致命性 CHD 相关；然而，女性代表性不足。三项研究报告称，GAD 与已确诊 CHD 的预后较差有关，且与抑郁无关。在 15 项研究中，3266 例患者中 GAD 的中位患病率为 10.4%，这表明 GAD 在 CHD 样本中的发病率略低于抑郁症。
越来越多的文献强调了担忧与 CHD 发生之间的关联。担忧、GAD 与 CHD 危险因素（如血压）和 HRV 之间的关联是导致心脏病发生的主要机制，可能会影响心血管功能。关于已确诊 CHD 中担忧和 GAD 的研究结果尚不清楚。
