Healthy people who are highly anxious about their health — even if they don’t quite meet the definition of hypochondriac — may be at greater risk of going on to develop heart disease, according to a Norwegian study published online last week in the journal BMJ Open.
As the authors of the study point out, earlier research has linked general anxiety to harmful effects on health, particularly cardiovascular health. But until now, apparently, no study had examined whether an increased risk of heart disease also applies to individuals whose anxiety takes the form of overly worrying about their health.
This new study’s answer to that question is not going to be reassuring if you’re among the group of people sometimes popularly referred to as the “worried well.” Fretting and fussing incessantly about your health (when you’ve been told by your doctor you have nothing to worry about) may not protect you from heart disease. In fact, it may have the opposite effect.
Health anxiety should, therefore, be taken seriously — and diagnosed and treated properly, the study’s authors conclude.
For the study, the researchers used data collected from a sampling of 7,052 people participating in the Hordalana Health Study (HUSK), a large, long-term research project being conducted in Norway. The participants, who were all born between 1953 and 1957, had completed a health questionnaire in 1997, at which time they had also undergone a physical examination, which included blood pressure and cholesterol readings, as well as several other heart-disease-related tests.
None of the HUSK participants used in the BMJ Open study had a history of heart disease in 1997, and individuals who developed heart disease within the study’s first year were not included in the final results to rule out the possibility that they had started the study with undiagnosed heart disease.
The participants were also given a widely accepted anxiety assessment, which included 14 questions on fears and concerns about having an illness. Individuals who scored above the 90th percentile on this portion of the assessment were considered to have health anxiety — a persistent preoccupation with acquiring or having a serious illness, despite the lack of any physical disease.
A total of 710 people (10 percent of the participants) met the criteria for having health anxiety.
The researchers tracked all the participants’ heart health for 12 years (until 2009), using national data on hospitalizations and deaths due to heart disease.
During the tracking period, 234 individuals (3.3 percent) developed heart disease — either a heart attack or a bout of acute angina. The average time to their first heart disease “incident” was seven years.
Among those with health anxiety, however, the rate was almost twice as high — 6 percent.
Established risk factors for heart disease — things like gender, smoking, body mass index, HDL cholesterol, blood pressure and physical activity — explained part of the association, but not all of it. After the data was adjusted to account for such factors, health anxiety was associated with a 73 percent increased risk of developing heart disease, the researchers report.
Their analysis also revealed that the higher the scores on the anxiety assessment, the stronger the link with the risk of heart disease.
Limitations and implications
These findings are not definitive. This study, like all studies, has several important limitations. Most notably, it shows only a correlation between health anxiety and heart disease risk, not a cause-and-effect relationship. Furthermore, although the study tried to rule out the possibility of “reverse causation” — that a person’s health anxiety was actually the result of an underlying health problem — it can’t be sure that it succeeded in this effort.
In other words, some of the people worrying about their health may have had a good reason to do so.
Still, as already noted, other research has also found a link between anxiety and heart disease. In fact, the authors of a 2010 meta-analysis concluded that anxiety should be considered an independent risk factor for heart disease.
“[Our research] further indicates that characteristic behaviour among persons with health anxiety, such as monitoring and frequent check-ups of symptoms, does not reduce the risk of [heart disease],” write the authors of the BMJ Open study (with British spellings).
The findings also illustrate, they add, “the dilemma for clinicians between reassuring the patient that current physical symptoms of anxiety do not represent heart disease, contrasted against the emerging knowledge of how anxiety, over time, may be causally associated with increased risk of [heart disease].”
FMI: You can read the study in full on the BJM Open website. You can find out more about anxiety disorders, including information on treatments and therapies, at the National Institute of Mental Health’s website.