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Anxiety disorders and risk of stroke: A systematic review and meta-analysis

Published online by Cambridge University Press:  27 January 2017

M. Pérez-Piñar ,
L. Ayerbe ,
E. González ,
R. Mathur ,
Q. Foguet-Boreu  and
S. Ayis
M. Pérez-Piñar
Affiliation:
The Westborough Road Health Centre, Westcliff on Sea, United Kingdom
L. Ayerbe*
Affiliation:
The Westborough Road Health Centre, Westcliff on Sea, United Kingdom Centre of Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
E. González
Affiliation:
Primary Care Unit, Department of Medicine, Autonoma University of Madrid, Madrid, Spain
R. Mathur
Affiliation:
Centre of Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
Q. Foguet-Boreu
Affiliation:
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Barcelona, Spain Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
S. Ayis
Affiliation:
Division of Health and Social Care, Kings College London, London, United Kingdom
*
⁎Corresponding author. Centre of Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58, Turner Street, E1 2AB London, United Kingdom. E-mail address: l.garcia-morzon@qmul.ac.uk (L. Ayerbe).
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Abstract

Background

Anxiety disorders are the most common mental health problem worldwide. However, the evidence on the association between anxiety disorders and risk of stroke is limited. This systematic review and meta-analysis presents a critical appraisal and summary of the available evidence on the association between anxiety disorders and risk of stroke.

Methods

Cohort studies reporting risk of stroke among patients with anxiety disorders were searched in PubMed, Embase, PsycINFO, Scopus, and the Web of Science, from database inception to June 2016. The quality of the studies was assessed using standard criteria. A meta-analysis was undertaken to obtain pooled estimates of the risk of stroke among patients with anxiety disorders.

Results

Eight studies, including 950,759 patients, from the 11,764 references initially identified, were included in this review. A significantly increased risk of stroke for patients with anxiety disorders was observed, with an overall hazard ratio: 1.24 (1.09–1.41), P = 0.001. No significant heterogeneity between studies was detected and the funnel plot suggested that publication bias was unlikely. Limited evidence suggests that the risk of stroke is increased shortly after the diagnosis of anxiety and that risk of stroke may be higher for patients with severe anxiety.

Conclusions

Anxiety disorders are a very prevalent modifiable condition associated with risk of stroke increased by 24%. This evidence could inform the development of interventions for the management of anxiety and the prevention of stroke. Further studies on the risk of stroke in patients with anxiety, and the explanatory factors for this association, are required.

Keywords

StrokeCohort studiesSystematic reviewAnxiety disorders
Type
Review
Information
European Psychiatry , Volume 41 , Issue 1 , March 2017 , pp. 102 - 108
Copyright
Copyright © European Psychiatric Association 2017

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