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Circulation, Vol 89, 1992-1997, Copyright © 1994 by American Heart Association
I Kawachi, GA Colditz, A Ascherio, EB Rimm, E Giovannucci, MJ Stampfer and WC Willett
BACKGROUND: To examine prospectively the association between self- reported
symptoms of phobic anxiety and subsequent risk of coronary heart disease, a
2-year follow-up study was conducted of a cohort of 33,999 US male health
professionals, aged 42 to 77 years in 1988, who were free of diagnosed
cardiovascular disease at baseline. Levels of phobic anxiety were assessed
using the Crown-Crisp index, a short, diagnostic self-rating scale used for
common phobias. Main outcomes were incidents of coronary heart disease
consisting of nonfatal myocardial infarction (MI) and fatal coronary heart
disease (CHD). METHODS AND RESULTS: One hundred sixty-eight incident cases
of CHD occurred during 2 years of follow-up (128 cases of nonfatal MI and
40 cases of fatal CHD). The age-adjusted relative risk of fatal CHD among
men with highest levels of phobic anxiety (scoring 4 or higher on the
Crown-Crisp index) was 3.01 (95% confidence interval, 1.31 to 6.90)
compared with men with the lowest levels of anxiety (scoring 0 or 1 on the
phobia index). Risk of fatal CHD increased with levels of phobic anxiety (P
trend = .002). When fatal CHD was further categorized into sudden and
nonsudden coronary death, the excess risk was confined to sudden death
(relative risk among men scoring 3 or higher on the phobia index was 6.08;
95% confidence interval, 2.35 to 15.73). No association was found between
phobic anxiety and risk of nonfatal MI. These findings remained essentially
unchanged after adjusting for a broad range of cardiovascular risk factors.
CONCLUSIONS: The specificity, strength, and dose-response gradient of the
association, together with the consistency and biological plausibility of
the experimental and epidemiologic evidence, support a strong causal
association between phobic anxiety and fatal CHD.
ARTICLES
Prospective study of phobic anxiety and risk of coronary heart disease in men
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115.
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