Prospective Study of Anxiety and Incident Stroke

+Author Affiliations

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.).

Correspondence to Maya J. Lambiase, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213. E-mailMJL106@pitt.edu

Abstract

Background and Purpose—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.

Methods—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.

Results—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.

Conclusions—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.

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