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Tension and Anxiety and the Prediction of the 10-Year Incidence of Coronary Heart Disease, Atrial Fibrillation, and Total Mortality: The Framingham Offspring Study

From the Eaker Epidemiology Enterprises, LLC, Chili, Wisconsin (E.D.E.); Department of Mathematics and Statistics, Boston University School of Public Health, Boston, Massachusetts (L.M.S., R.B.D.’A.); Departments of Neurology (M.K-H., R.B.D.), and Cardiology, Boston University School of Medicine, Boston, Massachusetts (E.J.B.); and The National Heart, Lung and Blood Institutes’ Framingham Heart Study, Bethesda, Maryland (L.M.S., M.K.-H., R.B.D.’A., E.J.B.)

Address correspondence and reprint requests to Elaine D. Eaker, ScD, Eaker Epidemiology Enterprises, LLC, 8975 County Road V, Chili, WI 54420. E-mail: eakerepi{at}tznet.com

Objective: Conflicting research findings regarding the ability of tension or anxiety to predict incident coronary heart disease (CHD) have created uncertainty in the literature. In addition, there are no prospective studies relating these characteristics to the development of atrial fibrillation (AF).

Methods: From 1984 to 1987, 3682 participants (mean age 48.5 ± 10.1 year; 52% women) of the Framingham Offspring Study were examined and followed for 10 years for the incidence of CHD, AF, and total mortality. Measures of tension, anxiety, and risk factors for CHD and AF were collected at the baseline examination.

Results: After adjusting for age, systolic blood pressure, body mass index, current cigarette smoking, diabetes, and total cholesterol/high-density cholesterol in Cox proportional hazards models, increased tension was predictive of 10-year incidence of definite CHD (relative risk (RR) = 1.25 relative to a one SD difference; 95% confidence interval (CI), 1.05–1.49) and total mortality (RR = 1.23; 95% CI, 1.06–1.42) in men. After adjusting for AF risk factors, tension also predicted AF in men (RR = 1.24; 95% CI, 1.04–1.48). Anxiety in men (RR = 1.22; 95% CI, 1.08–1.38), and in women (RR = 1.27; 95% CI, 1.05–1.55) was significantly related to total mortality.

Conclusions: Tension was observed to be an independent risk factor for incident CHD, AF, and mortality in men. Anxiety was a risk factor for total mortality in men and women. Our findings suggest that further research into the pathophysiology of the excess morbidity and mortality observed with tension and anxiety is merited.

Key Words: tension • anxiety • coronary heart disease • atrial fibrillation • mortality

Abbreviations: AF = atrial fibrillation; CHD = coronary heart disease; RR = relative risk; CI = confidence interval; BMI = body mass index.

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