People who needlessly worry that they have, or will develop, serious illness could increase their risk of heart disease, according to Norwegian research published today.
The “worried well” – those people who are preoccupied with having or acquiring a serious illness – are likely to have health anxiety. And because anxiety is a known risk factor for heart disease, their symptoms should be taken seriously, say researchers.
Writing in BMJ Open, the researchers describe how their observational study showed that those with health anxiety were 73% more likely to develop heart disease than those who did not have it.
“These findings illustrate the dilemma for clinicians between reassuring the patient that current physical symptoms of anxiety do not represent heart disease, contrasted against the emerging knowledge on how anxiety, over time, may be causally associated with increased risk of coronary artery disease,” researcher Dr Line Iden Berge, a psychiatrist in Bergen, Norway, writes.
They based their findings on studying 7,052 participants of the Norwegian Hordaland Health Study (HUSK), all of whom were born between 1953 and 1957.
Between 1997 and 1999, each filled in two questionnaires about their health, lifestyle, and educational attainment, and underwent a physical check-up, comprising blood tests, weight, height, and blood pressure measurements.
Anxiety levels were measured using the Whiteley Index, which comprises 14 items scored from 1-5. Out of the cohort, 710 had a total score of 31 or more – in the top 10% – and were considered to have health anxiety.
All participants’ heart health was tracked using national data on hospital treatment and death certification up to the end of 2009.
A total of 234 (3.3%) suffered a heart attack or bout of acute angina during the monitoring period, with the average time to the first incident just over seven years.
However, 6% of those with health anxiety developed heart disease, compared with 3% of participants who did not have health anxiety.
Even after taking into account other risk factors, the research team found that health anxiety was linked to a heightened risk.
Those with health anxiety at the start of the study were 73% more likely to develop heart disease than those who did not have it and the higher the Whiteley Index score, the greater the risk of developing heart disease.
Dr Berge and her colleagues write that it "further indicates that characteristic behaviour among persons with health anxiety, such as monitoring and frequent check-ups of symptoms, does not reduce the risk of events. If anything, putting the body on a permanent state of high alert may have the opposite effect."
The findings "underline the importance of proper diagnosis and treatment of health anxiety," they add.
Emily Reeve, from the British Heart Foundation, said: “It’s natural for people to worry if they feel they might be unwell. But anxiety and stress can trigger unhealthy habits, such as smoking or eating badly, which put you at greater risk of heart disease.
“While we don’t know if the ‘worried well’ are directly putting themselves at risk of a heart attack, it’s clear that reducing unnecessary anxiety can have health benefits. If you are experiencing health anxiety, speak to your doctor.”
Berge L, Skogens J, Sulo G et al. Health anxiety and risk of ischaemic heart disease: a prospective cohort study linking the Hordaland Health Study (HUSK) with the Cardiovascular Diseases in Norway (CVDNOR) project. BMJ Open doi 10.1136/bmjopen-2016-012914 [abstract]
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