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Shy and anxious men 'more at risk of a heart attack'

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What did the media say?

The media reported that men who are shy or anxious are at significantly greater risk of suffering a heart attack than the rest of the population. Previous research has often identified such a link with hostile Type A personalities.


What did the research show?

US researchers said anxiety had not been previously examined extensively as a risk factor for myocardial infarction, especially whether it was independent of other psychosocial factors.

They observed 735 men with a mean age of 60 over an average of 12.4 years. None of the men had prior history of coronary heart disease or diabetes at the start of the study. Researchers assessed their overall anxiety levels using four different anxiety scales – psychasthenia, social introversion, phobia and manifest anxiety.

They found the relative risk of MI increased by 37% with each increase on the scale for psychasthenia, 31% for social introversion, 36% for phobia and 42% for manifest anxiety. MI risk increased by 43% for each standard increase in overall anxiety, based on all four scales, the authors said.

They said the relationships remained significant after adjusting for a range of more traditionally recognised risk factors, such as smoking, hypertension, high cholesterol and depression.


What did the researchers say?

They concluded: ‘Anxiety-prone dispositions appear to be a robust and independent risk factor of MI among older men.’

Lead author Biing-Jiun Shen, an assistant professor of psychology at the University of Southern California in Los Angeles, added: ‘What we’re seeing is over and beyond what can be explained by blood pressure, obesity, cholesterol, age, cigarette smoking, blood sugar levels and other cardiovascular risk factors.

‘The good thing about anxiety is that it’s very treatable,’ he said. ‘Although more research is needed, we hope that by reducing anxiety, we can lower the future risk of heart attack. This is one more reason to seek help.’


What does this mean for nursing practice?

Judy O’Sullivan, cardiac nurse at the British Heart Foundation, was not that surprised by the findings. ‘It has long been established that poor mental health can have a negative impact on a person’s physical health and, sadly, can increase their risk of heart disease,’ she said.

‘Anxiety and other mental health issues, such as depression and social introversion, are complex in nature and the link between them and the increased risk of heart and circulatory disease are not fully understood,’ she added.

Journal of the American College of Cardiology (2008) 51: 113-119

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