Anxiety Predicted Premature All-cause and Cardiovascular Death in a 10-year Follow-up of Middle-aged Women

Objective: Research on emotional distress and mortality has largely focused on depression in men and in elderly populations. We examined the relation between anxiety and mortality in women at midlife, adjusting for depression.

Study Design And Setting: At baseline, 5,073 healthy Dutch women aged 46-54 years (mean=50.4+/-2.1) and living in Eindhoven, completed a three-item anxiety scale ("being anxious/worried," "feeling scared/panicky," "ruminating about things that went wrong;" Cronbach's alpha=0.77). The primary outcome was all-cause mortality at 10-year follow-up; secondary outcomes were cardiovascular and lung/breast cancer death.

Results: At follow-up, 114 (2.2%) women had died at the mean age of 56.4+/-3.1 years. Lung cancer (23%), cardiovascular disease (18%), and breast cancer (15%) were the major causes of death. Smoking, living alone, and lower education were related to mortality, but depression was not. Adjusting for these variables, anxiety was associated with a 77% increase in mortality risk (hazard ratio [HR]=1.77, 95% confidence interval [CI]: 1.14-2.74, P=0.011). Anxiety was related to cardiovascular death (HR=2.77, 95% CI: 1.17-6.58, P=0.021); there was also a trend for lung cancer death (HR=1.91, 95% CI: 0.90-4.06, P=0.095) but not for breast cancer death.

Conclusion: Anxiety predicted premature all-cause and cardiovascular death in middle-aged women, after adjustment for standard risk factors and depression.