Anxiety and cardiovascular disease.

This chapter examines the association of anxiety disorders and anxiety symptoms with cardiovascular disease, focussing on hypertension (an independent risk factor for myocardial infarction and stroke) and coronary heart disease. In both cases, epidemiological data linking the cardiovascular disorder with specific anxiety disorders and anxiety symptoms are examined first, and evidence relating to putative mechanisms that may underlie these associations is explored. For hypertension, an association with panic attacks and panic disorder has been reported most consistently, but the literature relating to other forms of anxiety is inconsistent, especially as some studies have reported an association of anxiety with low blood pressure. Recent work which has attempted to elucidate this confusing situation is presented. Mechanisms which may be responsible for the link between hypertension and panic include autonomic nervous system dysfunction (which may be under serotonergic control), respiratory mechanisms, cytokines, platelet dysfunction and behavioural factors. While an association of depression with coronary heart disease has been studied extensively, the association with anxiety disorders has been slower to emerge. Studies contributing to this evidence base are examined, and as for hypertension putative mechanisms are discussed.