From the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA (M.J.L., R.C.T.); and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.).
Stroke. 2014 Feb;45(2):438-43. doi: 10.1161/STROKEAHA.113.003741. Epub 2013 Dec 19.
Higher levels of anxiety are associated with increased risk for coronary heart disease. However, few studies have investigated whether anxiety is associated with stroke risk. The purpose of this study was to examine the association between anxiety symptoms and incident stroke in a nationally representative longitudinal study of the US population.
Participants (n=6019) in the First National Health and Nutrition Examination Survey were assessed at baseline and followed for 16.29±4.75 years. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals of incident stroke associated with a 1 SD increase in anxiety symptoms. Models were adjusted for standard cardiovascular risk factors and additionally for depression.
A total of 419 incident stroke cases were identified from hospital/nursing home discharge reports and death certificates. Reporting more anxiety symptoms at baseline was associated with increased risk of incident stroke after adjusting for standard biological and behavioral cardiovascular risk factors (hazard ratio, 1.14; 95% confidence interval, 1.03-1.25). Findings persisted when additionally controlling for depression. Exploratory analyses considering the role of potential confounding versus pathway variables suggested that behavioral factors may be a key pathway linking anxiety to stroke risk.
Higher anxiety symptom levels were associated prospectively with increased risk for incident stroke independent of other risk factors, including depression. Anxiety is a modifiable experience that is highly prevalent among the general population. Its assessment and treatment may contribute to developing more effective preventive and intervention strategies for improving overall cardiovascular health.
焦虑水平较高与冠心病风险增加相关。然而，很少有研究调查焦虑是否与中风风险相关。本研究的目的是在一项针对美国人群的全国代表性纵向研究中，检验焦虑症状与中风事件之间的关联。
在第一届国家健康和营养检查调查中，参与者（n=6019）在基线时进行评估，并随访 16.29±4.75 年。使用多变量 Cox 比例风险回归模型来估计与焦虑症状增加 1 个标准差相关的中风事件的风险比和 95%置信区间。模型调整了标准心血管风险因素，并进一步调整了抑郁。
从医院/疗养院出院报告和死亡证明中确定了 419 例中风事件。在调整了标准生物和行为心血管风险因素后，基线时报告更多的焦虑症状与中风事件风险增加相关（风险比，1.14；95%置信区间，1.03-1.25）。当进一步控制抑郁时，发现仍然存在。考虑潜在混杂与通路变量作用的探索性分析表明，行为因素可能是将焦虑与中风风险联系起来的关键途径。
更高的焦虑症状水平与前瞻性的中风事件风险增加相关，独立于其他风险因素，包括抑郁。焦虑是一种在普通人群中普遍存在的可改变的体验。对其进行评估和治疗可能有助于制定更有效的预防和干预策略，以改善整体心血管健康。
