Kawachi I, Sparrow D, Vokonas P S, Weiss S T
Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115.
Circulation. 1994 Nov;90(5):2225-9. doi: 10.1161/01.cir.90.5.2225.
Several studies have suggested an increased risk of fatal coronary heart disease (CHD) among patients with panic disorder, phobic anxiety, and other anxiety disorders. We prospectively examined this association in the Normative Aging Study.
An anxiety symptoms scale was constructed out of five items from the Cornell Medical Index, which was administered to the cohort at baseline. During 32 years of follow-up, we observed 402 cases of incident coronary heart disease (137 cases of nonfatal myocardial infarction, 134 cases of angina pectoris, and 131 cases of fatal CHD: made up of 26 cases of sudden cardiac death and 105 cases of nonsudden death). A nested case-control design (involving 1869 control subjects who remained free of diagnosed CHD) was used to assess the association between anxiety and risk of CHD. Compared with men reporting no symptoms of anxiety, men reporting two or more anxiety symptoms had elevated risks of fatal CHD (age-adjusted odds ratio [OR] = 3.20, 95% confidence interval [CI]: 1.27 to 8.09), and sudden death (age-adjusted OR = 5.73, 95% CI: 1.26 to 26.1). The multivariate OR after adjusting for a range of potential confounding variables was 1.94 (95% CI: 0.70-5.41) for fatal CHD and 4.46 (95% CI: 0.92-21.6) for sudden death. No excess risks were found for nonfatal myocardial infarction or angina.
These data suggest an association between anxiety and fatal coronary heart disease, in particular, sudden cardiac death.
多项研究表明，惊恐障碍、恐惧症焦虑症及其他焦虑症患者发生致命性冠心病（CHD）的风险增加。我们在规范老化研究中对这种关联进行了前瞻性研究。
从康奈尔医学指数的五个项目构建了一个焦虑症状量表，并在基线时对该队列进行了施测。在32年的随访期间，我们观察到402例冠心病事件（137例非致命性心肌梗死、134例心绞痛和131例致命性冠心病：包括26例心源性猝死和105例非猝死）。采用巢式病例对照设计（涉及1869名未被诊断为冠心病的对照受试者）来评估焦虑与冠心病风险之间的关联。与未报告焦虑症状的男性相比，报告有两种或更多焦虑症状的男性发生致命性冠心病的风险升高（年龄调整优势比[OR]=3.20，95%置信区间[CI]：1.27至8.09），心源性猝死风险升高（年龄调整OR=5.73，95%CI：1.26至26.1）。在对一系列潜在混杂变量进行调整后，致命性冠心病的多变量OR为1.94（95%CI：0.70-5.41），心源性猝死的多变量OR为4.46（95%CI：0.92-21.6）。未发现非致命性心肌梗死或心绞痛有额外风险。
这些数据表明焦虑与致命性冠心病之间存在关联，尤其是心源性猝死。
