Phobic Anxiety and Risk of Coronary Heart Disease and Sudden Cardiac Death Among Women

Abstract

Background— High levels of phobic anxiety have been associated with elevated risks of coronary heart disease (CHD) death and sudden cardiac death (SCD) among men. To the best of our knowledge, no studies have looked at this association among women. Anxiety may influence CHD mortality by increasing the risk of ventricular arrhythmia and SCD. Methods and Results— We prospectively examined the relationship between phobic anxiety, as measured by the Crown-Crisp index (CCI), and CHD among women participating in the Nurses’ Health Study. Among 72 359 women with no history of cardiovascular disease or cancer in 1988, 97 SCDs, 267 CHD deaths, and 930 nonfatal myocardial infarctions (MI) were documented over 12 years of follow-up. A higher score on the CCI was associated with an increased risk of SCD and fatal CHD but not of nonfatal MI in age-adjusted (P, trend ≤0.008) and in multivariable models excluding possible biological intermediaries (P, trend ≤0.03). Multivariable adjustment appeared to attenuate the rela...