Article Text

Health anxiety and risk of ischaemic heart disease: a prospective cohort study linking the Hordaland Health Study (HUSK) with the Cardiovascular Diseases in Norway (CVDNOR) project
  1. Line Iden Berge1,2,
  2. Jens Christoffer Skogen3,
  3. Gerhard Sulo2,
  4. Jannicke Igland2,
  5. Ingvard Wilhelmsen2,4,
  6. Stein Emil Vollset2,3,
  7. Grethe S Tell2,
  8. Ann Kristin Knudsen2,3
  1. 1Division of Psychiatry, Helse-Bergen, Sandviken University Hospital, Bergen, Norway
  2. 2Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
  3. 3Norwegian Institute of Public Health, Bergen, Norway
  4. 4Haraldsplass Deaconal University Hospital, Bergen, Norway
  1. Correspondence to Dr Line Iden Berge; line.iden.berge{at}


Background The risk of ischaemic heart disease (IHD) is largely influenced by lifestyle. Interestingly, cohort studies show that anxiety in general is associated with increased risk of IHD, independent of established risk factors for cardiovascular disease. Health anxiety is a specific type of anxiety characterised by preoccupation of having, acquiring or possibly avoiding illness, yet little is known about lifestyle and risk of disease development in this group.

Aim Investigate whether health anxiety is prospectively associated with IHD, and whether a potential association can be explained by the presence or absence of established risk factors for cardiovascular diseases.

Methods Incident IHD was studied among 7052 participants in the community-based Hordaland Health Study (HUSK) during 12 years follow-up by linkage to the Cardiovascular Diseases in Norway (CVDNOR) project. Scores above 90th centile of the Whiteley Index defined health anxiety cases. Associations were examined with the Cox proportional regression models.

Results During follow-up, 6.1% of health anxiety cases developed IHD compared with 3.0% of non-cases, yielding a gender-adjusted HR of 2.12 (95% CI 1.52 to 2.95). After adjustments for established cardiovascular risk factors, about 70% increased risk of IHD was found among cases with health anxiety (HR: 1.73 (95% CI 1.21 to 2.48)). The association followed a dose–response pattern.

Conclusions This finding corroborates and extends the understanding of anxiety in various forms as a risk factor for IHD. New evidence of negative consequences over time underlines the importance of proper diagnosis and treatment for health anxiety.

  • Health anxiety
  • Ischemic heart disease

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials