Bidirectional associations between anxiety disorders and myocardial infarction: a retrospective longitudinal cohort study

Despite anxiety and coronary heart disease being associated, longitudinal research investigating the bidirectional relationship between the formal diagnosis of anxiety disorders and myocardial infarction (MI) remains scarce. To investigate the bidirectional relationship between anxiety disorders and MI through a 15-year (2002–2016) longitudinal population-based retrospective cohort study using the National Health Insurance Research Database. We selected 34,979 patients diagnosed with an anxiety disorder based on their claim records during 2002–2004 and 5,189 patients with a diagnosis of MI based on their claim records during 2002–2004. In both analyses, the size of the comparison group was four times larger than that of the exposed group. A Cox proportional hazards model was used to estimate adjusted hazard ratios for developing anxiety disorders or MI after adjusting for sociodemographic factors. In the first analysis, patients with anxiety disorders had a statistically significant 1.28-fold higher risk of MI than those without. Among the patients with anxiety, those with higher age, male sex, or lower comorbidity had a significantly higher risk of MI after adjusting for sociodemographic variables. In the second analysis, patients with MI had a statistically significantly 2.08-fold higher risk of anxiety disorders than those without MI. Among the patients with MI, women and patients with lower comorbidities had a significantly higher risk of anxiety disorders after adjusting for sociodemographic variables. Our results demonstrate a meaningful connection between anxiety disorders and MI. By recognizing this relationship, healthcare providers can develop constructive strategies to effectively manage both conditions and improve patient outcomes.