The Role of Anxiety in Metabolic Syndrome

Expert Commentary

As science evolves and more complex mechanisms linking psychological and physiological functioning are disclosed, it becomes mandatory to address health in a holistic manner. Once we understand how human psychophysiology functions as an integrated system, both the physiological and the psychological variables involved can be manipulated to improve the organism's homeostasis.

In other words, if metabolic and psychological disorders both play a role in cardiovascular outcomes, both issues should be considered when addressing cardiac health and designing treatment and prevention interventions. In this sense, mental health professionals should also take responsibility for addressing detectable signs of metabolic disorders, such as visceral obesity, and unhealthy behaviors, such as tabagism, sedentarism and high-fat diet.

Although it is still necessary to determine whether addressing socioeconomic and behavioral factors in people with depression or high levels of anger or hostility could reduce the burden of MS, psychosocial distress is known to be a highly modifiable risk. Interventions such as psychosocial support, psychotherapy, regular exercise, stress reduction training and psychotropic medication have been shown to alter cardiac prognosis in populations with high cardiac risk.^[40]

Screening techniques are available to reliably determine if a patient is at risk for psychosocial stress-related health problems. The presence of this association indicates that the treatment of these diseases as part of secondary prevention in patients with anxiety and depression must be more rigorous and intensive than in patients without these psychiatric disorders.^[19] Among individuals suffering from anxiety and/or depression, adhesion to health recommendations is a cornerstone of cardiovascular disease prevention.

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