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Association of Anxiety With Resistance Vessel Dysfunction in Human Atherosclerosis

Stillman, Ashley N. BA; Moser, David J. PhD; Fiedorowicz, Jess MD, PhD; Robinson, Heather M. BS; Haynes, William G. MBChB, MD

doi: 10.1097/PSY.0b013e31829a0ae3
Original Articles

Objective Anxiety predicts cardiovascular events, although the mechanism remains unclear. We hypothesized that anxiety symptoms will correlate with impaired resistance and conduit vessel function in participants aged 55 to 90 years.

Methods Anxiety symptoms were measured with the Symptom Checklist-90—Revised in 89 participants with clinically diagnosed atherosclerotic cardiovascular disease and 54 healthy control participants. Vascular function in conduit arteries was measured using flow-mediated dilatation, and vascular function in forearm resistance vessels (FRVs) was measured using intra-arterial drug administration and plethysmography.

Results Anxiety symptoms were not associated with flow-mediated dilatation in either group. Participants with atherosclerosis exhibited significant inverse associations of anxiety symptoms with FRV dilatation (acetylcholine: β = −.302, p = .004). Adjustment for medication, risk factors, and depression symptoms did not alter the association between anxiety and FRV dysfunction, except for body mass index (BMI; anxiety: β = −.175, p = .060; BMI: β = −.494, p < .001). Although BMI was more strongly associated with FRV function than anxiety, combined BMI and anxiety accounted for greater variance in FRV function than either separately. Control participants showed no association of anxiety with FRV function.

Conclusions Anxiety is uniquely and substantially related to poorer resistance vessel function (both endothelial and vascular smooth muscle functions) in individuals with atherosclerosis. These relationships are independent of medication, depression, and cardiovascular risk factors, with the exception of BMI. These findings support the concept that anxiety potentially increases vascular events through worsening of vascular function in atherosclerotic disease.

From the Departments of Psychiatry (A.N.S., D.J.M., J.F., H.M.R.) and Internal Medicine (J.F., W.G.H.), University of Iowa Carver College of Medicine, Iowa City; and Department of Epidemiology (J.F.), College of Public Health, The University of Iowa, Iowa City, Iowa.

Address correspondence and reprint requests to David J. Moser, PhD, Department of Psychiatry, University of Iowa Carver College of Medicine, W278 General Hospital, Iowa City, IA 52242. E-mail:

Received for publication March 15, 2013; revision received March 29, 2013.

Copyright © 2013 by American Psychosomatic Society
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