Stress, Anxiety Linked to Greater Risk of Cardiovascular Disease, Diabetes in Aging Men

Lewina Lee, PhD

New research from the University of Boston and the National Center for Posttraumatic Stress Disorder at the US Department of Veterans Affairs is providing clinicians with insight into the impact of anxiety and mental stress on cardiovascular and diabetes risk in men.

An analysis of data from an ongoing 40-year study of male patients suggests higher anxiety levels in middle adulthood were associated with stable differences in cardiometabolic risk trajectories that were maintained into older ages and also suggests anxious individuals might experience earlier deteriorations in cardiometabolic health.

“While the participants were primarily white men, our findings indicate higher levels of anxiousness or worry among men are linked to biological processes that may give rise to heart disease and metabolic conditions, and these associations may be present much earlier in life than is commonly appreciated – potentially during childhood or young adulthood,” said Lewina Lee, PhD, lead author of the study, an assistant professor of psychiatry at Boston University School of Medicine, and an investigator and clinical psychologist at the National Center for Posttraumatic Stress Disorder at the U.S. Department of Veterans Affairs, in a statement.

Although anxiety has been linked to an increased risk of cardiometabolic disease, evidence gaps prevent clinicians from achieving a complete understanding of the mechanisms behind the association. With this in mind, Lee and fellow investigators sought to assess the prospective association of neuroticism and worry with cardiometabolic risk trajectories over a long-term period.

Leveraging data from the Normative Aging Study, investigators identified a sample of 1561 for inclusion in their final analyses. The Normative Aging Study was a longitudinal study of aging processes in men established by the VA Boston Outpatient Clinic that enrolled 2280 men between the ages of 21-80 years between 1961 and 1970. Investigators considered examination data from these patients through December 31, 2015.

As part of the Normative Aging Study, neuroticism and worry were assessed in a pair of mail surveys administered in 1975 that assessed neuroticism with 9 dichotomous items of the EPI-Q and worry using a content-based paper-and-pencil scale asking patients to rate how much they worry about various issues using 20 items on scale of 0-4. For inclusion in the investigators’ final analyses, patients need to complete at least 1 of the 2 mail surveys and have no missing data related to comorbidities or follow-up examinations.

At baseline, the analytic sample had a mean age of 53 years (SD, 8.4 years; range, 33–84 years), 91% were married, 97% were White, and the mean follow-up time was 22.9 (SD, 11.2) years. During the follow-up period, the mean number of examinations was 6.6 (SD, 3.4; range, 1-15), 219 men were seen within 3 years of the end of follow-up, and 1067 died.

For the purpose of analysis, investigators used mixed-effects regression to model cardiometabolic risk trajectories over age and assessed their associations with neuroticism and worry. Additionally, Cox regression was used to assess associations of neuroticism and worry with risk of having 6 or more cardiometabolic risk biomarkers through 2015.

Upon analysis, results indicated cardiometabolic risk increased at a rate of 0.8 markers per decade from age 33-65 years, at which point men had a mean of 3.8 high-risk factors. After 65 years, the rate of cardiometabolic risk factors increased at a rate of 0.5 markers per decade. Investigators pointed out higher neuroticism (B=0.08; 95% CI, 0.02-0.15) and worry levels (B=0.07; 95% CI, 0.001-0.13) were associated with increased risk over time. In adjusted analyses, this translated to 13% (95% CI, 1.03–1.23) and 10% (95% CI, 1.01–1.20) greater risks of having 6 or more cardiometabolic risk markers for higher neuroticism and worry, respectively.

“It would be important for future studies to evaluate if these associations exist among women, people from diverse racial and ethnic groups, and in more socioeconomically varying samples, and to consider how anxiety may relate to the development of cardiometabolic risk in much younger individuals than those in our study,” Lee added.

This study, “Neuroticism, Worry, and Cardiometabolic Risk Trajectories: Findings From a 40‐Year Study of Men,” was published in the Journal of the American Heart Association.