Anxiety Disorders and Risk of Myocardial Infarction: A Systematic Review and Meta-analysis of Cohort Studies

Anxiety disorders (AnxD) are prevalent mental disorders potentially linked to myocardial infarction (MI) risk. However, most studies assess anxiety as a symptom without referring to AnxD diagnosed using established diagnostic criteria. This systematic review and meta-analysis examined the association between different types of formally diagnosed AnxD and the risk of MI.

We searched PubMed and Scopus until February 2024 for cohort studies investigating formally diagnosed AnxD and its subtypes [panic disorder (PD), posttraumatic stress disorder (PTSD), and AnxD excluding reactions to severe stress] with fatal and non-fatal MI. Random-effects meta-analyses were conducted overall and by AnxD type. Heterogeneity was assessed by I 2 and small study effects with the Egger test.

We included 10 studies comprising over 567,000 participants and over 32,700 MI events. Overall, AnxD diagnosis was associated with higher MI risk [risk ratio (RR) = 1.43, 95% CI = 1.25 to 1.64, I 2 = 95%, n = 10]. Any AnxD excluding reactions to severe stress was also associated with higher MI risk (RR = 1.29, 95% CI = 1.06 to 1.59, I 2 = 92%, n = 4) and similar results were observed for PD (RR = 1.53, 95% CI = 1.25 to 1.88, I 2 = 92%, n = 4) and PTSD (RR = 1.58, 95% CI = 1.21 to 2.05, I 2 = 85%, n = 4).

AnxD, regardless of type, were consistently associated with an increased risk of MI compared with no AnxD. Future research needs to investigate the specific mechanisms and pathways underlying this association. As AnxD are common, but manageable mental disorders, an accurate diagnosis and proper treatment may reduce their adverse impact on cardiac health.