A Narrative Review of the Relationship Between Coronary Heart Disease and Anxiety

Context: Coronary heart disease (CHD) is the most common cause of death and disability in the world. While the relationship between depression and CHD is well documented, anxiety remains understudied, despite its common cooccurrence.
Evidence Acquisition: A PubMed (MEDLINE) search was conducted in order to find articles published between January 2000 and December 2015, using the following keywords: “coronary heart disease” and “anxiety”. In total, 79 out of 1138 articles were considered relevant by consensus between the authors and were reviewed.
According to previous studies, anxiety is suggested to increase the risk of CHD. Anxiety is associated with an increase in cardiac complications, morbidity and mortality. Also, a lower quality of life has been described among patients after acute coronary syndrome, with a few studies reporting contradictory findings. Although studies on anxiety management in CHD are sparse, selective serotonin reuptake inhibitors have been shown to be relatively safe for patients. On the other hand, psychological interventions have not been adequately evaluated, although some studies have revealed their advantages.
Evidence suggests that anxiety is associated with the development and course of CHD. Awareness and appropriate training in cardiology settings need to be prioritized to improve early identification and initiation of effective management.