Middle-aged men who are more anxious and worried may have a higher biological risk of developing heart disease, stroke and type 2 diabetes, also called cardiometabolic disease, as they age, according to new research published in the Journal of the American Heart Association , an open access journal of the American Heart Association.
Trajectories of neuroticism, worry, and cardiometabolic risk: findings from a 40-year study in men . Lewina O. Lee, Kevin J. Grimm, Avron Spiro III, and Laura D. Kubzansky https://doi.org/10.1161/JAHA.121.022006 Journal of the American Heart Association. 2022;11:e022006 Methods and Results The sample included 1561 men from an ongoing cohort of adult men. In 1975, healthy men (mean age, 53 years [SD, 8.4 years]) completed the neuroticism scale of the Eysenck Personality Inventory‐Short Form and a Worry Scale. Seven CMR biomarkers were evaluated every 3 to 5 years. The CMR score was the number of biomarkers categorized as high risk based on established cut-off points or medication use. Using mixed-effects regression, we modeled CMR trajectories across age and assessed their associations with neuroticism and worry. Using Cox regression, we examined the associations of neuroticism and worry with the risk of having ≥6 high-risk biomarkers for CMR through 2015. CMR increased by 0.8 markers per decade from age 33 to age 65, when that men had an average of 3.8 high-risk markers. risk markers, followed by a slower increase of 0.5 markers per decade. Higher levels of neuroticism (B=0.08; 95% CI, 0.02–0.15) and levels of worry (B=0.07; 95% CI, 0.001–0.13) were associated with elevated CMR over time, and with 13% (95% CI, 1.03–1.23) and 10% (95% CI, 1.01–1.20) increased risks, respectively, of having ≥ 6 high-risk CMR markers, adjusting for potential confounders. Results In middle adulthood, higher levels of anxiety are associated with stable differences in cardiometabolic risk that persist into older ages. Anxious people may experience declines in cardiometabolic health earlier in life and remain on a stable trajectory of higher risk at older ages. |
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“While participants were primarily white men, our findings indicate that higher levels of anxiety or worry among men are related to biological processes that can lead to heart disease and metabolic conditions, and these associations may be present much earlier in life than is commonly believed. – potentially during childhood or early adulthood,” said Lewina Lee, Ph.D., lead author of the study, assistant professor of psychiatry at Boston University School of Medicine and researcher and clinical psychologist at the National Center for Post-Traumatic Stress Disorder. at the United States Department of Veterans Affairs, both in Boston.
To track the relationship between anxiety and risk factors for cardiometabolic diseases over time, researchers analyzed data from participants in the Normative Aging Study, which is a longitudinal study of aging processes in men, founded in the US Veterans Affairs outpatient clinic in Boston in 1961. The study includes both veterans and non-veterans. This analysis included 1,561 men (97% white), who had an average age of 53 years in 1975.
The men completed baseline assessments of neuroticism and worry and were free of cardiovascular disease and cancer at the time. A personality inventory assessed neuroticism on a scale from 0 to 9. Additionally, a worry assessment tool asked how often they worried about each of 20 items, where 0 meant never and 4 meant all the time.
“ Neuroticism is a personality trait characterized by a tendency to interpret situations as threatening, stressful and/or overwhelming. “People with high levels of neuroticism are likely to experience negative emotions, such as fear, anxiety, sadness and anger, with greater intensity and frequency,” Lee said.
“ Worry refers to our attempts to solve a problem whose future outcome is uncertain and potentially positive or negative. Worry can be adaptive, for example, when it leads us to constructive solutions. However, worry can also be harmful, especially when it becomes uncontrollable and interferes with our daily functioning.”
After their initial evaluation, the men underwent physical examinations and blood tests every 3 to 5 years until they died or left the study. The research team used follow-up data through 2015.
During follow-up visits, seven cardiometabolic risk factors were measured: systolic blood pressure (top number); diastolic blood pressure (lower number); total cholesterol; triglycerides; obesity (assessed by body mass index); fasting blood sugar levels; and erythrocyte sedimentation rate (ESR), a marker of inflammation.
A risk factor for cardiometabolic disease was considered in the high-risk range if the test results for the risk factor were higher than the cut-point established by national guidelines, or if the participant was taking any medication to control that risk factor (such as cholesterol-lowering medications). Cutoffs for ESR as a risk factor are not standardized, so a participant was classified as high risk if they were in the top 25% of those screened.
Each participant was assigned a risk factor count score, one point for each of the seven risk factors classified as high risk. The men were then stratified based on whether or not they developed six or more high-risk factors during the follow-up period.
“Having six or more high-risk cardiometabolic markers suggests that an individual is very likely to develop or has already developed a cardiometabolic disease,” Lee said.
The researchers found:
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We found that the risk of cardiometabolic disease increased as men aged, from ages 30 to 80, regardless of anxiety levels, while men who had higher levels of anxiety and worry were consistently more likely to develop cardiometabolic disease over time than those with lower levels. of anxiety or worry,” Lee said.
The researchers did not have data on whether the participants had been diagnosed with an anxiety disorder. Standard evidence-based treatment for anxiety disorders includes psychotherapy or medication, or a combination of both.
“While we don’t know if treating anxiety and worry can reduce cardiometabolic risk, people who are anxious and prone to worry should pay more attention to their cardiometabolic health. For example, by getting routine health checkups and being proactive in managing your cardiometabolic disease risk levels (such as taking medications for high blood pressure and maintaining a healthy weight), you can decrease your chance of developing cardiometabolic diseases. . Lee said.
It is unclear to what extent the results of this analysis are generalizable to the public, as the study participants were all male and almost all white. Furthermore, although the participants were followed for four decades, they were middle-aged when the study began.
“It would be important for future studies to evaluate whether these associations exist among women, people from diverse racial and ethnic groups, and in more socioeconomically variable samples, and to consider how anxiety may be related to the development of cardiometabolic risk in individuals much younger than those of our studio,” Lee said.
Clinical Perspective In a cohort of initially healthy middle-aged men, higher baseline levels of 2 forms of anxiety, neuroticism and worry, were associated with a 10% to 13% increased risk of being classified as high risk on ≥6 risk biomarkers. cardiometabolic. such as blood pressure and fasting glucose, during 40 years of follow-up. The magnitude of the cardiometabolic risk difference by baseline neuroticism and worry levels was maintained throughout the follow-up period but did not widen with advancing age. What are the clinical implications? Anxiety may affect cardiometabolic health earlier in the life course than previously thought. Efforts to prevent cardiometabolic disease have generally targeted screening and lifestyle modifications among middle-aged and older adults; However, findings from this and other studies increasingly suggest that assessment of cardiometabolic and psychological risk factors beginning much earlier in life may have an impact. |
Co-authors are Kevin J. Grimm, Ph.D.; Avron Spiro III, PhD; and Laura D. Kubzansky, MPH, Ph.D. Author disclosures are listed in the manuscript.
The study was supported by the National Institute on Aging and the National Center for Advancing Translational Sciences, which are divisions of the National Institutes of Health.
