Key result
Treatment-naive GAD linked to ~21% lower HR response to deep breathing, indicating reduced cardiovagal tone.
Why the study?
Generalised anxiety disorder is linked to autonomic dysfunction and elevated cardiovascular morbidity, but cardiovagal tone needed comprehensive evaluation in newly diagnosed, treatment-naive patients using validated Ewing's tests.
Does Generalised Anxiety Disorder impair cardiovagal tone compared to healthy controls?
Case-Control (n=80)
Technician blinded to group status
No
Does Generalised Anxiety Disorder impair cardiovagal tone compared to healthy controls?
Effect estimate: p=0.009 for HRDB
Absolute Event Rate: 21.61% vs 27.35%
p-value: p=0.009
Newly diagnosed, treatment-naive GAD patients exhibit significant cardiovagal dysfunction, suggesting early autonomic imbalance that may serve as a marker for elevated cardiovascular risk.
Introduction Generalised anxiety disorder (GAD) is a prevalent psychiatric condition increasingly associated with autonomic nervous system dysfunction. Specifically, impaired cardiovagal tone, a marker of reduced parasympathetic modulation of cardiac function, has been linked to emotional dysregulation, behavioural rigidity, and elevated cardiovascular morbidity. The standard Ewing’s battery of parasympathetic autonomic function tests provides a reproducible and non-invasive means of assessing such dysfunction. This study aimed to comprehensively evaluate cardiovagal tone in newly diagnosed, treatment-naive GAD patients using validated Ewing’s tests. Methods In this cross-sectional case-control study, 40 GAD patients (aged 31 to 40 years) diagnosed per the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria were compared with 40 age- and sex-matched healthy controls. Cardiovagal tone was assessed using the standard Ewing’s battery: heart rate response to deep breathing (HRDB), expiration:inspiration (E:I) ratio, Valsalva ratio, and the 30:15 ratio during the head-up tilt test (HUT). Results The GAD patients demonstrated significantly lower HRDB (21.61 ± 9.75 vs. 27.35 ± 9.64 beats/min, p = 0.009) and E:I ratio (1.29 ± 0.26 vs. 1.47 ± 0.20, p = 0.001) compared to controls, indicating reduced parasympathetic (vagal) activity. The Valsalva ratio (p = 0.410) and 30:15 ratio (p = 0.664) showed no statistically significant differences. These findings underscore the presence of early, subclinical autonomic imbalance in GAD, particularly affecting the cardiovagal domain. Conclusion Treatment-naive GAD patients exhibit significant cardiovagal dysfunction, as reflected by reduced heart rate variability and E:I ratio. Impaired cardiovagal tone is an independent risk factor for adverse cardiovascular outcomes and may serve as a physiological marker of early brain-heart axis disruption. Routine application of Ewing’s parasympathetic test battery may assist in cardiovascular risk stratification and guide holistic neurocardiac management in anxiety disorders.
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Priya et al. (2026) conducted a case-control in Treatment-naive adults aged 31-40 years with newly diagnosed generalised anxiety disorder per DSM-5 criteria (n=80). Generalised anxiety disorder (GAD) patients vs. Age- and sex-matched healthy controls was evaluated on Cardiovagal tone assessed by heart rate response to deep breathing (HRDB) and expiration:inspiration ratio (E:I ratio) (p=0.009 for HRDB, p=0.009). Treatment-naive GAD patients had significantly lower heart rate response to deep breathing (21.61 ± 9.75 beats/min) compared to controls (27.35 ± 9.64 beats/min, p=0.009), indicating reduced cardiovagal tone.
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