Abstract
Anxiety produces maladaptive cardiovascular changes and accelerates biological aging. We evaluated cardiovascular reactivity in young and middle-aged individuals with varying anxiety scores to test the hypothesis that anxiety mimics cardiovascular aging by influencing cardiovascular autonomic modulation. The State-Trait Anxiety Inventory was used to classify healthy young individuals (20–29 years) into high (YHA, n=22;10 men) and low (YLA, n=21;10 men) anxiety, and to identify middle-aged individuals (50–60 years) with low anxiety (MLA, n=22;11 men). Heart rate, blood pressure (BP) and their variability (HRV and BPV, respectively) and baroreflex function were analyzed from beat-to-beat finger BP and electrocardiogram recordings collected during 5-min baseline, 6-min speech task (ST) and 3-min post ST recovery. Analyses of covariance showed significant differences (P<0.05) at baseline for HRV, BPV and barorelfex, and low-frequency power of systolic BP variability (LFSBP) was lower, whereas baroreflex and high frequency (HF) normalized units were higher in the YLA compared with YHA and MLA groups. Compared with YLA, YHA and MLA displayed attenuated vagal withdraw response (HF) to ST. BP and LFSBP responses to ST in YHA and MLA were higher compared with the YLA group. These findings suggest that anxiety could be linked to cardiovascular aging as it attenuates cardiac reactivity and exaggerates vascular responses to stress.
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References
Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc 2009; 18 (1): 23–33.
Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation 1994; 90 (5): 2225–2229.
Eaker ED, Sullivan LM, Kelly-Hayes M, D'Agostino RB Sr, Benjamin EJ . Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham Offspring Study. Psychosom Med 2005; 67 (5): 692–696.
O'Donovan A, Slavich GM, Epel ES, Neylan TC. Exaggerated neurobiological sensitivity to threat as a mechanism linking anxiety with increased risk for diseases of aging. Neurosci Biobehav Rev 2013; 37 (1): 96–108.
Seldenrijk A, van Hout HP, van Marwijk HW, de Groot E, Gort J, Rustemeijer C et al. Depression, anxiety, and arterial stiffness. Biol Psychiatry 2011; 69 (8): 795–803.
Yeragani VK, Tancer M, Seema KP, Josyula K, Desai N. Increased pulse-wave velocity in patients with anxiety: implications for autonomic dysfunction. J Psychosom Res 2006; 61 (1): 25–31.
Shinba T, Kariya N, Matsui Y, Ozawa N, Matsuda Y, Yamamoto K. Decrease in heart rate variability response to task is related to anxiety and depressiveness in normal subjects. Psychiatry Clin Neurosci 2008; 62 (5): 603–609.
Virtanen R, Jula A, Salminen JK, Voipio-Pulkki LM, Helenius H, Kuusela T et al. Anxiety and hostility are associated with reduced baroreflex sensitivity and increased beat-to-beat blood pressure variability. Psychosom Med 2003; 65 (5): 751–756.
Beckers F, Verheyden B, Aubert AE. Aging and nonlinear heart rate control in a healthy population. Am J Physiol Heart Circ Physiol 2006; 290 (6): H2560–H2570.
Fan AZ, Strine TW, Jiles R, Mokdad AH. Depression and anxiety associated with cardiovascular disease among persons aged 45 years and older in 38 states of the United States, 2006. Prev Med 2008; 46 (5): 445–450.
De Meersman RE, Stein PK. Vagal modulation and aging. Biol Psychol 2007; 74 (2): 165–173.
Tahvanainen A, Koskela J, Tikkakoski A, Lahtela J, Leskinen M, Kahonen M et al. Analysis of cardiovascular responses to passive head-up tilt using continuous pulse wave analysis and impedance cardiography. Scand J Clin Lab Invest 2009; 69 (1): 128–137.
Dhingra R, Vasan RS. Age as a risk factor. Med Clin North Am 2012; 96 (1): 87–91.
Millasseau SC, Kelly RP, Ritter JM, Chowienczyk PJ. Determination of age-related increases in large artery stiffness by digital pulse contour analysis. Clin Sci (Lond) 2002; 103 (4): 371–377.
Charkoudian N, Rabbitts JA. Sympathetic neural mechanisms in human cardiovascular health and disease. Mayo Clin Proc 2009; 84 (9): 822–830.
Seals DR, Moreau KL, Gates PE, Eskurza I. Modulatory influences on ageing of the vasculature in healthy humans. Exp Gerontol 2006; 41 (5): 501–507.
Epel ES, Lin J, Wilhelm FH, Wolkowitz OM, Cawthon R, Adler NE et al. Cell aging in relation to stress arousal and cardiovascular disease risk factors. Psychoneuroendocrinology 2006; 31 (3): 277–287.
Adkisson EJ, Casey DP, Beck DT, Gurovich AN, Martin JS, Braith RW. Central, peripheral and resistance arterial reactivity: fluctuates during the phases of the menstrual cycle. Exp Biol Med (Maywood) 2010; 235 (1): 111–118.
Spielberger CD, Gorsuch RL, Lushene RE . Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press: Palo Alto, CA, USA, 1970, pp 1–10.
Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996; 67 (3): 588–597.
Strand BH, Dalgard OS, Tambs K, Rognerud M. Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord J Psychiatry 2003; 57 (2): 113–118.
Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci 1974; 19 (1): 1–15.
Tambs K, Moum T. How well can a few questionnaire items indicate anxiety and depression? Acta Psychiatr Scand 1993; 87 (5): 364–367.
Gobel FL, Norstrom LA, Nelson RR, Jorgensen CR, Wang Y. The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation 1978; 57 (3): 549–556.
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93 (5): 1043–1065.
Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 1986; 59 (2): 178–193.
Rahman F, Pechnik S, Gross D, Sewell L, Goldstein DS. Low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Clin Auton Res 2011; 21 (3): 133–141.
Burr RL. Interpretation of normalized spectral heart rate variability indices in sleep research: a critical review. Sleep 2007; 30 (7): 913–919.
Parati G, Liu X, Ochoa JE, Bilo G. Prognostic relevance of blood pressure variability: role of long-term and very long-term blood pressure changes. Hypertension 2013; 62 (4): 682–684.
Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation 1991; 84 (2): 482–492.
Borst C, Karemaker JM. Time delays in the human baroreceptor reflex. J Auton Nerv Syst 1983; 9 (2-3): 399–409.
Westerhof BE, Gisolf J, Stok WJ, Wesseling KH, Karemaker JM. Time-domain cross-correlation baroreflex sensitivity: performance on the EUROBAVAR data set. J Hypertens 2004; 22 (7): 1371–1380.
Roest AM, Martens EJ, de Jonge P, Denollet J . Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol 2010; 56 (1): 38–46.
Roest AM, Martens EJ, Denollet J, de Jonge P . Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis. Psychosom Med 2010; 72 (6): 563–569.
Mankus AM, Aldao A, Kerns C, Mayville EW, Mennin DS. Mindfulness and heart rate variability in individuals with high and low generalized anxiety symptoms. Behav Res Ther 2013; 51 (7): 386–391.
Pittig A, Arch JJ, Lam CW, Craske MG. Heart rate and heart rate variability in panic, social anxiety, obsessive-compulsive, and generalized anxiety disorders at baseline and in response to relaxation and hyperventilation. Int J Psychophysiol 2012; 87 (1): 19–27.
Tahvanainen A, Leskinen M, Koskela J, Ilveskoski E, Nordhausen K, Oja H et al. Ageing and cardiovascular responses to head-up tilt in healthy subjects. Atherosclerosis 2009; 207 (2): 445–451.
Yu BH, Kang EH, Ziegler MG, Mills PJ, Dimsdale JE. Mood states, sympathetic activity, and in vivo beta-adrenergic receptor function in a normal population. Depress Anxiety 2008; 25 (7): 559–564.
Seery MD. Challenge or threat? Cardiovascular indexes of resilience and vulnerability to potential stress in humans. Neurosci Biobehav Rev 2011; 35 (7): 1603–1610.
Koch DW, Leuenberger UA, Proctor DN. Augmented leg vasoconstriction in dynamically exercising older men during acute sympathetic stimulation. J Physiol 2003; 551 (Pt 1): 337–344.
Lipman RD, Grossman P, Bridges SE, Hamner JW, Taylor JA. Mental stress response, arterial stiffness, and baroreflex sensitivity in healthy aging. J Gerontol A Biol Sci Med Sci 2002; 57 (7): B279–B284.
McEniery CM, Yasmin, Hall IR, Qasem A, Wilkinson IB, Cockcroft JR . Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol 2005; 46 (9): 1753–1760.
Mattace-Raso FU, van den Meiracker AH, Bos WJ, van der Cammen TJ, Westerhof BE, Elias-Smale S et al. Arterial stiffness, cardiovagal baroreflex sensitivity and postural blood pressure changes in older adults: the Rotterdam Study. J Hypertens 2007; 25 (7): 1421–1426.
Barthel P, Bauer A, Muller A, Huster KM, Kanters JK, Paruchuri V et al. Spontaneous baroreflex sensitivity: prospective validation trial of a novel technique in survivors of acute myocardial infarction. Heart Rhythm 2012; 9 (8): 1288–1294.
Madden K, Savard GK. Effects of mental state on heart rate and blood pressure variability in men and women. Clin Physiol 1995; 15 (6): 557–569.
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We are thankful to the participants and Preston Brown for his valuable contribution in data acquisition.
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Sanchez-Gonzalez, M., Guzik, P., May, R. et al. Trait anxiety mimics age-related cardiovascular autonomic modulation in young adults. J Hum Hypertens 29, 274–280 (2015). https://doi.org/10.1038/jhh.2014.72
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DOI: https://doi.org/10.1038/jhh.2014.72
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