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. 2014 Jul 11:5:80.
doi: 10.3389/fpsyt.2014.00080. eCollection 2014.

Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

John A Chalmers  1 , Daniel S Quintana  2 , Maree J-Anne Abbott  1 , Andrew H Kemp  3
Affiliations

Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis

John A Chalmers et al. Front Psychiatry. .

Abstract

Background: Anxiety disorders increase risk of future cardiovascular disease (CVD) and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV), may be one mechanism linking anxiety disorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis.

Method: Studies comparing resting-state HRV recordings in patients with an anxiety disorder as a primary diagnosis and healthy controls were considered for meta-analysis.

Results: Meta-analyses were based on 36 articles, including 2086 patients with an anxiety disorder and 2294 controls. Overall, anxiety disorders were characterized by lower HRV [high frequency (HF): Hedges' g = -0.29. 95% CI: -0.41 to -0.17, p < 0.001; time domain: Hedges' g = -0.45, 95% CI: -0.57 to -0.33, p < 0.001] than controls. Panic disorder (n = 447), post-traumatic stress disorder (n = 192), generalized anxiety disorder (n = 68), and social anxiety disorder (n = 90), but not obsessive-compulsive disorder (n = 40), displayed reductions in HF HRV relative to controls (all ps < 0.001).

Conclusion: Anxiety disorders are associated with reduced HRV, findings associated with a small-to-moderate effect size. Findings have important implications for future physical health and well-being of patients, highlighting a need for comprehensive cardiovascular risk reduction.

Keywords: anxiety; anxiety disorders; cardiovascular disease; heart rate variability; meta-analysis; treatment.

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Figures

Figure 1
Figure 1
Selection of articles for inclusion. Note: diagnostic grouping of studies do not add to 36 due to some studies reporting on multiple diagnoses.
See this image and copyright information in PMC

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