Health anxiety might increase the risk of heart disease, research finds.
A meta-analysis found that anxious people have a 48 percent higher risk of dying from a heart problem.
Heart disease is the leading cause of death among Americans, according to the Centers for Disease Control and Prevention (CDC), killing 365,000 people in 2014.
New research suggests that the consequences of health anxiety are also serious and the condition should be treated properly.
Health anxiety describes a patient's excessive worrying over having a serious illness, and seeking medical advice in the absence of a physical disease.
Patients with health anxiety misread physical symptoms as serious illnesses, and they often seek repeated medical help for the same issues. In its most intense form, health anxiety becomes hypochondria.
Health anxiety and heart disease
Researchers led by Line Iden Berge, from the Helse Bergen hospital in Bergen, Norway, examined the link between health anxiety and heart disease. The results were published in the online journal BMJ Open.
Berge and team worked with participants in the Norwegian Hordaland Health Study (HUSK). This long-term study followed participants over a period of 12 years, and it was a collaboration between the National Health Screening Service, the University of Bergen, and local health services.
The 7,052 participants were born between 1953-1957. For the study, they had to answer questions about their health, lifestyle, and educational achievement.
Between 1997-1999, they underwent blood tests, weight, height, and blood pressure measurements.
Participants were also asked to report their anxiety levels using the Whiteley Index. Scores above 90 percent were considered to be anxiety cases.
Health anxiety raised heart disease risk by 73 percent
During follow-up, twice as many participants with health anxiety developed heart disease, compared with those who did not report any anxiety. Around 6.1 percent of health anxiety cases developed ischemic heart disease (IHD), compared with 3 percent of non-cases.
Because participants had been enrolled in a nationwide research project monitoring heart disease, their heart health was monitored extensively. The national program, entitled "Cardiovascular diseases in Norway," was carried out between 1994-2009, so the study could track participants using national hospital data and death certificates up to 2009.
After adjustments for established cardiovascular risk factors, researchers found a 73 percent increased risk of developing IHD among cases with health anxiety.
Even considering established risk factors for IHD, such as smoking, high cholesterol, and education, health anxiety was a high risk factor for IHD.
The risk of IHD also increased proportionally with the level of reported anxiety; the stronger the symptoms of health anxiety, the higher the risk of IHD.
Regarding gender, a very slight increase in IHD risk was noticed in women with health anxiety over their male counterparts.
Trust your heart
Caveats to the results of the study include the fact that this is an observational study, telling us little about the cause-and-effect relation between anxiety and IHD.
Also, health anxiety is often associated with other mental health issues, such as general anxiety and depression, so the different types of anxiety and ways in which they increase the risk of heart disease can be difficult to differentiate.
"[Our study] further indicates that characteristic behavior among persons with health anxiety, such as monitoring and frequent check-ups of symptoms, does not reduce the risk of [coronary heart disease] events," the researchers write.
On the contrary, keeping the body in a constant state of alert might further increase the risk of heart-related incidents.
This puts both patients with anxiety and doctors in a difficult position. Telling an anxious patient that their anxiety is not a symptom of heart disease might help, but on the other hand, informing them that health anxiety might induce heart disease over time could cause them even more anxiety.
The researchers say:
"These findings illustrate the dilemma for clinicians between reassuring the patient that current physical symptoms of anxiety do not represent heart disease, contrasted against the emerging knowledge on how anxiety, over time, may be causally associated with increased risk of [coronary artery disease]."
The findings "underline the importance of proper diagnosis and treatment of health anxiety," the team adds.
The authors conclude that "this finding might encourage patients to seek treatment for health anxiety and to trust their heart."