Aims While elevated levels of anxiety are associated with worse prognosis of cardiovascular disease (CVD), this association may vary between different aspects of anxiety. The aim of this study was to analyse self-reported behavioural, physiological, affective, and cognitive aspects of anxiety and their relation to the risk of recurrent CV events. Methods and results This prospective cohort study utilized data from the U-CARE Heart trial. Participants (N = 935, post myocardial infarction) answered the Hospital Anxiety and Depression Scale (HADS: Anxiety subscale) and the Cardiac Anxiety Questionnaire (CAQ: Fear, Avoidance & Attention subscales). HADS Anxiety reflected physiological aspects, CAQ Fear reflected cognitive and affective aspects, CAQ Avoidance reflected behavioural aspects, and CAQ Attention reflected cognitive aspects of anxiety. Cox Regression was used to estimate the risk between anxiety and recurrent major adverse cardiac event (MACE). During the follow-up period (mean 2.9 years), 124 individuals (13%) experienced a specified MACE endpoint. HADS Anxiety and CAQ Total were both associated with increased risk of MACE (HR = 1.52, 95% CI: 1.15-2.02 and HR = 1.30, 95% CI: 1.04-1.64, respectively). Among the CAQ subscales, there was support for an association between Avoidance and risk of MACE (HR = 1.37, 95% CI 1.15-1.64), but not for Attention and Fear. Conclusion The results support that anxiety is associated with an increased risk of recurrent MACE in post-MI patients. The association between anxiety and risk was strong for the aspects of anxiety relating to behaviour and physiology, while the support for an association with cognitive and affective aspects was lacking.

中文翻译：

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焦虑与复发性心血管事件的关联：调查焦虑的不同方面

目的 虽然焦虑水平升高与心血管疾病 (CVD) 的预后较差相关，但这种关联在焦虑的不同方面可能有所不同。本研究的目的是分析自我报告的焦虑的行为、生理、情感和认知方面及其与心血管事件复发风险的关系。方法和结果 这项前瞻性队列研究利用了 U-CARE Heart 试验的数据。参与者（N = 935，心肌梗死后）回答了医院焦虑和抑郁量表（HADS：焦虑分量表）和心脏焦虑问卷（CAQ：恐惧、回避和注意力分量表）。 HADS 焦虑反映了生理方面，CAQ 恐惧反映了认知和情感方面，CAQ 回避反映了行为方面，CAQ 注意力反映了焦虑的认知方面。 Cox 回归用于评估焦虑与复发性主要不良心脏事件 (MACE) 之间的风险。在随访期间（平均 2.9 年），124 人 (13%) 经历了特定的 MACE 终点。 HADS 焦虑和 CAQ 总分均与 MACE 风险增加相关（分别为 HR = 1.52，95% CI：1.15-2.02 和 HR = 1.30，95% CI：1.04-1.64）。在 CAQ 分量表中，支持回避与 MACE 风险之间存在关联（HR = 1.37，95% CI 1.15-1.64），但不支持注意力和恐惧。结论 结果支持焦虑与 MI 后患者复发 MACE 风险增加相关。对于与行为和生理相关的焦虑方面，焦虑与风险之间的关联很强，而与认知和情感方面的关联则缺乏支持。