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Anxiety: the heart of the matter

MagazineJune 2011 (Vol. 22 Issue 3)Anxiety: the heart of the matter

If you're one of the millions of people worldwide suffering with an anxiety disorder, you could be at an increased risk of heart disease and heart-related death, according to two recent studies

If you're one of the millions of people worldwide suffering with an anxiety disorder, you could be at an increased risk of heart disease and heart-related death, according to two recent studies.

The first one, by researchers from Tilburg University in the Netherlands, surveyed the pooled data derived from 20 earlier studies involving nearly 250,000 people in total. It found that anxiety was associated with a 26-per-cent increased risk of coronary heart disease and a 48-per-cent increased risk of cardiac death over the 11-year follow-up period, even after adjusting for the known heart-disease risk factors (J Am Coll Cardiol, 2010; 56: 38-46).

The second study, from Stockholm, Sweden, also found that anxiety disorders are predictive of future heart disease, even after controlling for other risk factors such as blood pressure and smoking.

The authors analyzed the data from roughly 50,000 Swedish men (aged 18 to 20 years) who had been examined for military service and subsequently follow-ed for an average of 37 years. They discovered that those with anxiety-as diagnosed by a psychiatrist-were more than twice as likely to suffer from coronary heart disease or have a heart attack in the future (J Am Coll Cardiol, 2010; 56: 31-7).
Both studies, published in the peer-reviewed Journal of the American College of Cardiology, appeared in the same issue along with an accompanying editorial by psychiatrist Dr Joel E. Dimsdale, from the University of California at San Diego.

"It is odd that anxiety symp-toms can be such a strong beacon, lighting the way to future coronary disease decades in advance," Dr Dimsdale wrote in his commentary.

But he also pointed out that there are several other plausible explanations for the findings. Sleep disturbance, for example, often goes hand-in-hand with anxiety, and could be contribu-ting to various aspects of cardio-vascular disease.

Although further studies are needed to see whether or not therapies aimed at alleviating anxiety would reduce cardio-vascular risk, according to Dr Dimsdale, "the wise clinician might 'assume' that treatment of anxiety disorders might have benefits beyond immediate symptomatic and functional improvement" (J Am Coll Cardiol, 2010; 56: 47-8).

Indeed, heart disease is not the only physical condition to be linked to anxiety. Previous research has discovered that anxiety disorders are indepen-dently associated with a wide variety of physical health problems, including thyroid disease, migraine headaches, respiratory disorders, gastro-intestinal disease, arthritis and allergic conditions (Arch Intern Med, 2006; 166: 2109-16).
Treating anxiety promptly and effectively, therefore, may have significant benefits for the body as well as the mind.

Treating anxiety

Anxiety is something we all suffer from at times-it's a normal reaction to stress. But when anxiety becomes excessive and irrational, and interferes with everyday life, it's time to get help.

There are several different anxiety disorders, including panic disorder, obsessive-compulsive disorder (OCD), phobias and generalized anxiety disorder (GAD), and each has its own distinct symptoms and treatment options. Usually, the treatment is based on so-called 'antianxiolytic' drugs, such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, but these come with a host of unwanted side-effects, such as dependency, reduced alertness, sexual dys-function and even suicidal thoughts (Nutr J, 2010; 9: 42).

Fortunately, there are a number of safer, effective alter-natives available to help people who have persistent anxiety.

u Cognitive behavioural therapy (CBT). So far, CBT, a form of counselling, has proven to be the most effective long-term treatment for anxiety-related disorders (Nutr J, 2010; 9: 42). In a review of 13 trials investigating the use of CBT in children and adolescents with various anxiety disorders, the overall response rate was 56 per cent with CBT compared with 28 per cent for the controls (Cochrane Database Syst Rev, 2005; 4: CD004690).
u Herbs. A variety of herbal remedies can treat anxiety, the most popular of which is the South Pacific plant kava-kava (Piper methysticum). Indeed, a literature review of all randomized, double-blind, placebo-controlled studies found kava-kava extract to be "an effective symptomatic treatment option for anxiety" (Cochrane Database Syst Rev, 2003; 1: CD003383).
However, there have been concerns over its safety, leading some countries-including the UK-to ban it. Although some experts believe the ban is unwarranted, until the safety issues are cleared away, other herbs might be a better option.
v Chamomile (Matricaria recutita). In 57 patients with mild-to-moderate GAD, taking a chamomile extract was significantly better than a placebo at reducing symptoms (J Clin Psychopharmacol, 2009; 29: 378-82).
v Valerian (Valeriana officina-lis). This traditional herb may be useful for certain anxiety-related symptoms, such as nervousness, sleep disturbance and depression (Z Arztl Fortbild Qualit"atssich, 2001; 95: 33-4).
v Passionflower (Passiflora incarnata). This herb has a long history of use as an anti-anxiety agent in traditional folklore, and has been used by people all over the world to treat anxiety (Nutr J, 2010; 9: 42).
In a double-blind random-ized controlled trial, passion-flower proved to be just as effective as the benzodiazepine drug oxazepam for GAD (J Clin Pharm Ther, 2001; 26: 363-7).
u Supplements. A UK study of
80 healthy male volunteers found that taking a daily multivitamin/mineral tablet (containing calcium, magnes-ium and zinc) was more effective than a placebo for reducing anxiety and stress (Psychopharmacology [Berl], 2000; 150: 220-5).
Other supplements that may also help are 5-hydroxy-tryptophan (5-HTP), and the amino acids l-lysine and l-arginine taken in combination (Int Clin Psychopharmacol, 1987; 2: 33-45; Biomed Res, 2007; 28: 85-90). Indeed, a recent scientific review concluded that there is "strong evidence" supporting the use of supplements that contain combinations of l-lysine and l-arginine as treat-ments for anxiety symptoms and disorders (Nutr J, 2010; 9: 42).
For those who suffer with panic disorder, inositol, part of the vitamin B-complex, may
be an effective remedy for reducing the frequency and severity of panic attacks, according to a double-blind trial (Am J Psychiatry, 1995; 152: 1084-6).
u Massage. One small study suggests that light-pressure massage may be useful for patients with GAD (Complement Ther Clin Pract, 2009; 15: 96-101), while massage combined with aromatherapy can also help, although the benefits tend to be short-lived (Br J Gen Pract, 2000; 50: 493-6).
u Relaxation therapy. There is consistent evidence supporting the use of relaxation tech-niques to treat GAD and other anxiety disorders. A pooled meta-analysis of 27 studies concluded that relaxation therapy (specifically, Jacob-son's progressive relaxation, autogenic training, applied relaxation and meditation) can all significantly reduce anxiety (BMC Psychiatry, 2008; 8: 41).
u Exercise. Physical activity appears to be a powerful antidote to stress and anxiety, and is often recommended
for anxiety disorders and depression.
According to one report, the best results can be seen with rhythmic, aerobic-type exercises of moderate-to-low intensity (such as jogging, swimming, cycling and walk-ing). Sessions should be carried out in 15- to 30-minute bouts at a minimum frequency of three times a week in programmes lasting 10 weeks or longer (Psychiatr Pol, 2004; 38: 611-20).
u Yoga. Research suggests that yoga, which combines relaxa-tion techniques with exercise, is particularly useful for anxiety. In one randomized controlled trial, attending a 90-minute yoga class twice a week for two months led to a significant reduction in perceived levels of anxiety in women suffering from anxiety disorders (Complement Ther Clin Pract, 2009; 15: 102-4).
More recently, US scientists at the Boston University School of Medicine reported that performing yoga postures was associated with increased levels of gamma-aminobutyric acid (GABA) levels in the brain, which could explain its anti-anxiety effects. They also found that, in healthy people, regular yoga practice was more effective than a walking intervention for improving mood and anxiety (J Altern Complement Med, 2010; 16: 1145-52).
u Transcranial magnetic stimu-lation (TMS). So far, the pre-liminary evidence suggests that this non-invasive technique- which works by stimulating neurons in the brain-may be useful for controlling anxiety. Although the results thus far have been mixed, TMS has been reported to reduce anxiety symptoms in post-traumatic stress and panic disorders (Int Clin Psychopharmacol, 2009; 24: 163-73).

Joanna Evans

Factfile: Symptoms of anxiety disorders

If you have an anxiety disorder, your chief symptom will be feeling anxious. However, this can lead to other psychological and physical symptoms, including:
u sleeping difficulties
u tiredness
u lack of concentration
u feeling out of control of your actions
u a fear that you're 'going mad'
u dry mouth
u diarrhoea
u rapid heartbeat or palpitations
u dizziness
u shortness of breath
u shaking
u chest pain or tightness
u difficulty swallowing
u needing to urinate more often than usual.

Factfile: Other approaches

u Cut out caffeine. People who suffer from anxiety disorders tend to be unusually sensitive to the effects of caffeine, so even small amounts may exacerbate symptoms.
u Consider food allergies, which can be a triggering factor for anxiety in some cases. Suspect an allergy if symptoms occur after eating or if they improve with fasting, or if you have other allergy-related disorders, such as migraines, asthma, rhinitis or irritable bowel syndrome. An elimination diet followed by individual food challenges can usually pinpoint which foods are the culprits (Townsend Lett, 2004; October).
u Avoid alcohol and other sedatives, as they can worsen anxiety.

WDDTY VOL. 22 NO. 2


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