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‘Worried well’ at increased risk of heart disease, study finds

People who needlessly worry about health problems – commonly referred to as the ‘worried well’ – may be at increased risk of heart disease as a result, according to the findings of a large new study.

The findings suggest GPs should make more effort to identify the worried well and treat their health anxiety, to help reduce their risk of developing heart disease, said authors of the report.

The researchers used the Whiteley Index, a hypochondriasis screening tool, to screen over 7,000 people for health anxiety – a persistent preoccupation with having, or developing, serious illness despite not having any physical disease.

A total of 701 met the criteria for having health anxiety, with scores of 31 or higher.

Over 12 years of follow-up, 6% of health anxiety cases had an ischaemic heart disease event compared with just 3% of non-cases.

After adjusting for pre-existing cardiovascular disease risk factors, people with health anxiety had about a 70% increased risk of heart disease relative to those without.

The researchers said this implied that rather than reducing their risk of heart disease through increased concern about symptoms, the worried well may be causing the opposite due to their anxiety placing increased strain on their bodies.

The team acknowledged that they could not draw firm conclusions about whether health anxiety actually causes heart disease, and that identifying health anxiety on its own can be difficult, as it often co-exists with other mental health problems including generalised anxiety.

Nonetheless the concluded that their findings ‘illustrate the dilemma for clinicians between reassuring the patient that current physical symptoms of anxiety do not represent heart disease, contrasted against the emerging knowledge on how anxiety, over time, may be causally associated with increased risk of ischaemic heart disease’.

The findings, based on the Norwegian Hordaland Health Study (HUSK) – a long term collaborative research project between the National Health Screening Service, the University of Bergen, and local health services – ‘underline the importance of proper diagnosis and treatment of health anxiety’, the team added.

BMJ Open 2016; available online 3 November


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