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July 12, 2010
The President Post
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Health
Study: Anxiety in Youth Linked
to Heart Attacks Later on
As many as 28 percent of people are diagnosed with anxiety
at some point in their lives
By Amanda Gardner
Image: www.competitiveintelligence.ning.com
“Anxiety increases adrenaline; stress and anxiety
trigger an adverse response,” says Dr. Tracy Stevens,
M.D., a spokesperson for the American Heart
Association. This stress could affect the fatty plaque
lining coronary arteries; if the plaque ruptures, it can
lead to clots and heart attacks.
Men diagnosed with
anxiety in their
late teens or early
20s are more than
twice as likely to
have heart disease
or a heart attack later in life than
their more laid-back peers, according
to a new Swedish study.
As many as 28 percent of people
are diagnosed with anxiety at
some point in their lives, according
to an editorial accompanying
the study in the Journal of the
American College of Cardiology.
Anxiety is more than feeling
stressed out. People with anxiety
disorders feel excessive or irrational
worry and can have anxietyrelated
physical symptoms, such
as fatigue, headaches, trembling,
sweating, panic, and nausea.
Experts have a number of hypotheses
as to why anxiety and
heart disease may be linked,
though the new research can’t
confirm that anxiety -- not some
other factor -- is the cause of heart
disease and heart attacks in the
study.
“Anxiety increases adrenaline;
stress and anxiety trigger an adverse
response,” says Dr. Tracy
Stevens, M.D., a spokesperson
for the American Heart Association
and a cardiologist with Saint
Luke’s Mid America Heart Institute,
in Kansas City, Missouri.
This stress could affect the fatty
plaque lining coronary arteries; if
the plaque ruptures, it can lead to
clots and heart attacks.
However, that’s just a theory at
the moment, says Stevens, who
was not involved in the research.
Although it’s known that anxiety
can affect blood pressure and
heart disease-related chest pain in
the short term, the long-term effects
are unknown.
“It’s a very provocative observation
to say that one’s state of anxiety
at a fixed point in time can
in some way foretell an increased
risk of cardiovascular disease 20
years down the road,” says Dr.
Gregory Dehmer, M.D., professor
of internal medicine at Texas
A&M Health Science Center
College of Medicine and director
of the cardiology division at Scott
& White, in Temple.
“It would be terribly premature
to base any kind of therapeutic
decision on this,” he says. “If a patient
says they’re anxious and the
doctor puts them on an anti-anxiety
drug for 25 years to prevent
a heart attack, that’s a huge leap
of faith.”
There is, however, already a
fairly well-established link between
depression and a heightened
risk for heart disease.
The new study involved almost
50,000 Swedish men born
between 1949 and 1951 who
were undergoing medical examinations
for military service. A
research team, led by Dr.Imre
Janszky, M.D., Ph.D., of the
Karolinska Institute, in Stockholm,
looked at the men for the
next 37 years, a feat made possible
by the fact that Sweden has
universal health coverage and
maintains detailed records on patients.
Unlike previous researchers,
these authors found no link between
depression and heart disease
or heart attack. But they
did find that people with anxiety
had more than double the risk of
heart disease and two-and-a-half
times the risk of suffering a heart
attack.
All the men classified as having
anxiety or depression had
been diagnosed by a psychiatrist,
a big plus for the study. However,
the authors admit, certain risk
factors for heart disease, such as
cholesterol, were not fully taken
into account.
In a second report in the same
issue of the journal, researchers
combined data from 20 studies,
including a total of almost
250,000 healthy people from
Norway, the Netherlands, Russia,
Sweden, Japan, and Britain.
The participants were followed
for an average of about 11 years
by a team led by Annelieke Roest
of Tilburg University, in the
Netherlands.
In this study, people with anxiety
had a 26 percent increase in
the risk of heart disease and a 48
percent increase in the risk of dying
of heart-related causes.
There was also a hint of an association
between anxiety and
nonfatal heart attacks, but this
information was based only on
five studies and was not statistically
significant.
Still, there may be something
physicians and their patients can
do, which they probably should
be doing anyway.
“If a person has a diagnosis of
an anxiety disorder, such as panic
disorder or phobia -- not if they’re
just nervous or tense -- I would be
more likely to tighten up on lipid
levels and blood pressure,” says
Lawrence Hergot, M.D., professor
of medicine and director of
general cardiology, University of
Colorado Health Sciences Center,
in Denver.
Low “Good” Cholesterol
Linked to Cancer Risk
By Amanda Gardner
People who have low levels
of the so-called good
cholesterol have long been
known to be at higher risk
of heart attacks and heart disease.
Now, a new study suggests they
may have a higher risk of cancer,
too.
Each 10-point increase in good
cholesterol—known as highdensity
lipoprotein (HDL)—corresponds
to a 36% decrease in a
person’s risk of developing cancer,
the study found.
Guidelines say that men and
women should keep their HDL
over 40 and 50 mg/dL, respectively,
though everyone should
shoot to maintain levels above 60
mg/dL.
The study doesn’t prove that
low HDL actually causes cancer.
Nor does it prove that boosting
your HDL — exercise and
healthy eating are two ways to do
it — will reduce the risk of cancer,
as it has been shown to do
with heart disease.
For
now,
the best
prescription for
raising HDL is an
old-fashioned one:
Eat right, stay fit, and
quit smoking.
Cholesterol levels — both
good and bad — tend to plummet
in people with cancer, so low
HDL “might just be a marker of
people who are about to die from
cancer” rather than a contributing
factor, says the lead author of
the study, Richard Karas, MD,
executive director of the Molecular
Cardiology Research Institute
at Tufts Medical Center, in
Boston.
Low HDL might also simply
be a sign of an unhealthy lifestyle
that may itself up cancer risk,
since people who exercise regularly,
have a healthy diet, and don’t
smoke tend to have higher levels
of HDL. Although the researchers
controlled for health factors
such as age, body mass index,
and smoking in order to zero in
on the effect of cholesterol, other
unidentified lifestyle factors may
have shaped the results.
In the study, which appears in
the June 22 issue of the Journal
of the American College of Cardiology,
Dr. Karas and his colleagues
re-analyzed data from 24
clinical trials that included nearly
150,000 generally healthy people.
The trials were originally designed
to test the effectiveness of
statin medications, which lower
bad cholesterol (known as LDL).
How HDL may affect cancer
risk is still a mystery. HDL may
boost the immune system’s ability
to fight precancerous lesions
and cancerous tumors lurking in
the body, Dr. Karas says.
Another possibility is that
HDL has antioxidant properties
that neutralize chemical compounds
in the body that contribute
to cancer by damaging cells.
A third explanation is that HDL
may reduce inflammation, which
is associated with both heart disease
and cancer.
The study should bring some
long overdue attention to HDL,
which has been unjustly overshadowed
by its evil twin, LDL,
says Peter Alagona Jr., MD, the
director of general cardiology at
the Penn State Heart and Vascular
Institute, in Hershey.
Part of the reason is that blockbuster
statin medications can
lower
bad
cholesterol,
but can’t
do much to raise
HDL, says Dr. Alagona,
who was not involved
in the new research.
Raising HDL with medication
is indeed trickier, says
Jennifer Robinson, MD, program
director of the Lipid
Research Clinic at the University
of Iowa, in Iowa City.
Prescription niacin pills can
help raise HDL slightly, she
says, but there are few effective
prescription drugs available.
“We don’t know that giving
someone a drug to raise
HDL will prevent cancer, or
even heart disease,” says Dr.
Robinson, who wrote an editorial
accompanying Dr.
Karas’s study.
For now, the best prescription
for raising HDL is an
old-fashioned one: Eat right,
stay fit, and quit smoking.
“Do everything you can
in terms of weight control
[and] quitting smoking,”
says Jay Brooks, MD, chairman
of the hematology and
oncology department at the
Ochsner Clinic Foundation
in Baton Rouge, La.
“We don’t have any good
pharmacologic means of
raising HDL really well at
this point, so concentrate on
the things you can do the
best.”
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