Anxiety and new onset of cardiovascular disease: critical review and meta-analysis

<jats:sec><jats:title>Background</jats:title><jats:p>Anxiety has been associated with new-onset cardiovascular disease (CVD), but the quality of this relationship is unclear. Only if anxiety is a causal, independent cardiovascular risk factor might it be a target for CVD prevention.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To determine and examine the independent association and causality between anxiety and incident CVD.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>PubMed, EMBASE and PsycINFO databases were searched up to October 2013. A review of Hill's criteria for causality and random effects meta-analysis were conducted of prospective, population-based studies examining anxiety and incident CVD in people free from CVD at baseline.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The meta-analysis comprised 37 papers (<jats:italic>n</jats:italic>= 1 565 699). The follow-up ranged from 1 to 24 years. Anxiety was associated with a 52% increased incidence of CVD (hazard ratio = 1.52, 95% CI 1.36–1.71). The risk seemed independent of traditional risk factors and depression. The evaluation of Hill's criteria largely argued in favour of causality.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Anxiety may be of interest for CVD prevention. Future research should examine biological and behavioural underpinnings of the association in order to identify targets for intervention.</jats:p></jats:sec>