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(Circulation. 2005;111:480-487.)
© 2005 American Heart Association, Inc.

Cardiovascular Disease in Women

Phobic Anxiety and Risk of Coronary Heart Disease and Sudden Cardiac Death Among Women

Christine M. Albert, MD, MPH; Claudia U. Chae, MD, MPH; Kathryn M. Rexrode, MD, MPH; JoAnn E. Manson, MD, DPH; Ichiro Kawachi, MD, PhD

From the Division of Preventive Medicine (C.M.A., C.U.C., K.M.R., J.E.M.) and Channing Laboratory (J.E.M., I.K.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School; the Cardiology Division (C.M.A., C.U.C.), Department of Medicine, Massachusetts General Hospital and Harvard Medical School; and the Departments of Epidemiology (J.E.M.) and Society, Human Development, and Health (I.K.), Harvard School of Public Health, Boston, Mass.

Correspondence to Dr Christine Albert, Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave East, Boston, MA 02215-1204. E-mail calbert{at}partners.org

Received July 15, 2004; accepted December 7, 2004.

Background— High levels of phobic anxiety have been associated with elevated risks of coronary heart disease (CHD) death and sudden cardiac death (SCD) among men. To the best of our knowledge, no studies have looked at this association among women. Anxiety may influence CHD mortality by increasing the risk of ventricular arrhythmia and SCD.

Methods and Results— We prospectively examined the relationship between phobic anxiety, as measured by the Crown-Crisp index (CCI), and CHD among women participating in the Nurses’ Health Study. Among 72 359 women with no history of cardiovascular disease or cancer in 1988, 97 SCDs, 267 CHD deaths, and 930 nonfatal myocardial infarctions (MI) were documented over 12 years of follow-up. A higher score on the CCI was associated with an increased risk of SCD and fatal CHD but not of nonfatal MI in age-adjusted (P, trend 0.008) and in multivariable models excluding possible biological intermediaries (P, trend 0.03). Multivariable adjustment appeared to attenuate the relations; women who scored 4 or greater on the CCI were at a 1.59-fold (95% CI, 0.97 to 2.60) marginally increased risk of SCD and a 1.31-fold (95% CI, 0.97 to 1.75) marginally increased risk of fatal CHD compared with those who scored 0 or 1. After control for possible intermediaries (hypertension, diabetes, and elevated cholesterol), a trend toward an increased risk persisted for SCD (P=0.06).

Conclusions— These prospective data suggest that high levels of phobic anxiety are associated with an increased risk of fatal CHD, particularly from SCD. Some but not all of this risk can be accounted for by CHD risk factors associated with phobic anxiety.

Key Words: death, sudden • women • arrhythmia • stress

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