The Role of Anxiety in Metabolic Syndrome

Conclusion

MS is likely to develop in patients in whom genetic predisposition, chronic stress, negative emotion and unhealthy lifestyle habits converge. Anxiety and depressive disorders are linked to higher cardiometabolic risk, higher incidence of acute cardiovascular events and poorer prognosis for cardiac patients. In addition, they seem to be comorbid to a range of other chronic internal diseases. The current literature on the metabolic mediation of this relationship provides evidence for an association between psychological characteristics and the development of MS, which could eventually increase cardiovascular disease risk.

The authors consider the results presented here of considerable interest, once the link between psychological variables, such as depression and stress, and cardiovascular problems have long been established and the current literature points to an independent role of anxiety and negative cardiovascular outcome. This review shows that even though there is considerable evidence for the role of anxiety in cardiovascular problems, state-of-the-art literature does not support that metabolic alterations are a plausible physiological underlying pathway for this association. Negative health behaviors and hypothalamic dysregulation and sympathetic hyperactivation are the most commonly mentioned plausible underlying pathways (see Figure 1).

(Enlarge Image)

Figure 1.

Psychological factors, metabolic syndrome and cardiac risk. HPA: Hypothalamic–pituitary–adrenal.

Prospective data, although limited, suggest that depression, stress, hostility and anger, but not anxiety, independently predict increased risk of developing MS. The coexistence of anxiety in MS patients seems to be a byproduct of anxiety–depression or anxiety–stress comorbidity. The HPA axis dysregulation observed in MS patients may also be explained by alternative factors, such as visceral obesity's influence on HPA axis activity. Adverse functioning of the ECS can also mediate the stress–fat distribution relationship.

More prospective studies conducted with diverse samples are needed to delineate the direction of this relationship and to assess the roles of the proposed behavioral mechanisms. To test for causality, further animal experimental investigations might provide more reliable evidence. Even though the details of the causal process remain unclear, one can certainly affirm that patients presenting with psychological distress, such as anxiety, depressive symptoms and chronic stress, are in danger of metabolic alterations and of a negative cardiovascular prognosis. This is because the constant activation of the HPA and the sympathetic nervous system promoted by anxiety responses triggers cardiovascular dysregulations such as elevated heart rate and blood pressure.^[53]

Table 1. Current evidence on the association of anxiety and depression and metabolic syndrome.
Study (year)	Sample	Outcome	Ref.
Cohen et al. (2010)	1024 stable CAD outpatients	Higher levels of depression were significantly associated with increased prevalence of MS	[16]
Holt et al. (2009)	2997 subjects	Depression increases risk for diabetes	[17]
Engum (2007)	37291 subjects	Diabetes could not be considered a predictor of depression or anxiety. The presence of depression and anxiety represented a significant risk for onset of Type 2 diabetes	[20]
Takeuchi et al. (2009)	1183 men	MS can predict the development of depression	[24]
Hildrum et al. (2009)	9571 subjects	No association of anxiety and depression with MS	[25]
Raikkonen et al. (2002)	425 women	Psychological risk factors, particularly anger, predicted the development of MS	[26]
Dunbar et al. (2008)	1690 subjects	Participants with MS with or without diabetes presented higher scores on depression scales than individuals without MS. No association was found with psychological distress or anxiety	[28]
Petrlova et al. (2004)	116 subjects	In MS patients, depression was approximately four-times more prevalent than in the general population	[29]
Bonnet et al. (2009)	840 hypertensive subjects with MS	In hypertensive subjects with MS, depressive symptoms were independently associated with unhealthy lifestyles	[30]
Skilton et al. (2007)	1598 subjects	MS was related to an increased prevalence of depression but not anxiety	[31]
Toker et al. (2008)	2355 men and 1525 women	Depression among women, but not men, was associated with a twofold increased risk of MS and elevated glucose levels	[32]
Nishnia et al. (2011)	1613 subjects	Depression was associated with MS and glucose abnormality in men	[33]
Vogelzangs et al. (2007)	2917 elderly patients	An association between depressive and MS symptoms was found in white but not in black participants. Anxiety symptoms were significantly associated with MS in men, but not in women	[34]
Herva et al. (2006)	5698 subjects	No clear association of MS with depression or anxiety	[45]
van Reedt Dortland et al. (2010)	1217 anxious and depressive patients	MS was associated with severity of depression and with tricyclic antidepressant use, but not with anxiety	[47]
Carroll et al. (2009)	4256 men	Generalized anxiety disorder, but not major depressive disorder, was associated with MS	[50]

Table 1. Current evidence on the association of anxiety and depression and metabolic syndrome.

Study (year)

Sample

Outcome

Ref.

Cohen et al. (2010)

1024 stable CAD outpatients

Higher levels of depression were significantly associated with increased prevalence of MS

[16]

Holt et al. (2009)

2997 subjects

Depression increases risk for diabetes

[17]

Engum (2007)

37291 subjects

Diabetes could not be considered a predictor of depression or anxiety. The presence of depression and anxiety represented a significant risk for onset of Type 2 diabetes

[20]

Takeuchi et al. (2009)

1183 men

MS can predict the development of depression

[24]

Hildrum et al. (2009)

9571 subjects

No association of anxiety and depression with MS

[25]

Raikkonen et al. (2002)

425 women

Psychological risk factors, particularly anger, predicted the development of MS

[26]

Dunbar et al. (2008)

1690 subjects

Participants with MS with or without diabetes presented higher scores on depression scales than individuals without MS. No association was found with psychological distress or anxiety

[28]

Petrlova et al. (2004)

116 subjects

In MS patients, depression was approximately four-times more prevalent than in the general population

[29]

Bonnet et al. (2009)

840 hypertensive subjects with MS

In hypertensive subjects with MS, depressive symptoms were independently associated with unhealthy lifestyles

[30]

Skilton et al. (2007)

1598 subjects

MS was related to an increased prevalence of depression but not anxiety

[31]

Toker et al. (2008)

2355 men and 1525 women

Depression among women, but not men, was associated with a twofold increased risk of MS and elevated glucose levels

[32]

Nishnia et al. (2011)

1613 subjects

Depression was associated with MS and glucose abnormality in men

[33]

Vogelzangs et al. (2007)

2917 elderly patients

An association between depressive and MS symptoms was found in white but not in black participants. Anxiety symptoms were significantly associated with MS in men, but not in women

[34]

Herva et al. (2006)

5698 subjects

No clear association of MS with depression or anxiety

[45]

van Reedt Dortland et al. (2010)

1217 anxious and depressive patients

MS was associated with severity of depression and with tricyclic antidepressant use, but not with anxiety

[47]

Carroll et al. (2009)

4256 men

Generalized anxiety disorder, but not major depressive disorder, was associated with MS

[50]

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

The Role of Anxiety in Metabolic Syndrome

Conclusion

Tables

References

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar

Key Issues

Figure 1.

Figure 1.

Comments

Email This

Feedback