Previous research has indicated that phobic anxiety is associated with coronary heart disease. In this study, the possible association between social anxiety and various anthropometric, metabolic, and endocrine measurements known to be associated with cardiovascular disease were studied in a population-based cohort of 216 women 41–42 years old. Each participant was assessed by means of a DSM-IV based self-report questionnaire regarding social anxiety and related psychiatric diagnoses. Waist-to-hip ratio (WHR), body mass index (BMI), and serum levels of lipids and hormones were assessed. The prevalence of social anxiety was 14% (n=31). The social anxiety group displayed higher serum levels of triglycerides (1.3±0.9 vs. 1.0±0.5, P=0.003) and low-density lipoprotein (LDL) (3.3±0.8 vs. 3.0±0.7, P=0.03), but lower high-density lipoprotein (HDL) (1.4±0.3 vs. 1.6±0.4, P=0.04) and HDL/LDL ratio (0.46±0.15 vs. 0.57±0.22, P=0.008) than the other women. Serum levels of total testosterone (1.6±0.8 vs. 2.2±1.1, P=0.013) and free thyroxin (14±2 vs. 16±4, P=0.04) were lower in subjects confirming social anxiety. While WHR was significantly higher in the social anxiety group (0.83±0.06 vs. 0.80±0.07, P=0.016), BMI did not differ between the groups. Our data suggest that self-reported social anxiety is associated with two established risk factors for cardiovascular disease: dyslipidemia and increased WHR.
Social anxiety denotes a condition characterized by extreme discomfort upon exposure of the possible scrutiny of unfamiliar people. When this discomfort leads to avoidance of the anxiety provoking situations and thereby interferes with the professional or social life, the diagnosis social phobia is warranted (American Psychiatric Association, 1994 and Kessler et al., 1998b). These patients are at risk for social isolation, markedly compromised quality of life, and impaired psychosocial functioning (Mendlowicz and Stein, 2000 and Kessler, 2003). The prevalence of social phobia ranges from 2% to 15%—higher among women than men—which makes social phobia one of the most common psychiatric disorders (Schneier et al., 1992, Kessler et al., 1994, Weiller et al., 1996, Kessler et al., 1998a and Pelissolo et al., 2000).
An increasing body of literature suggests that not only depression (Musselman et al., 1998, Penninx et al., 2001 and Rudisch and Nemeroff, 2003), but panic disorders (Zaubler and Katon, 1996 and Fleet et al., 2000) and phobic anxiety, which is a construct closely related to panic disorder (Gorman and Sloan, 2000), are associated with enhanced morbidity in cardiovascular disease (Haines et al., 1987, Kawachi et al., 1994a, Kawachi et al., 1994b and Haines et al., 2001). Recently, seven possible mechanisms for the relationship between depression and cardiovascular disease were overviewed (Joynt et al., 2003). Among them was a hyperactive hypothalamic-pituitary–drenocortical (HPA) axis, which has been found in depressed patients (Ehlert et al., 2001 and Pariante, 2003) and that is known to damage the cardiovascular system. Another mechanism could be risk factor clustering. Several studies have namely found that depression, anxiety, and psychosocial distress are associated with anthropometric and metabolic risk factors for arteriosclerosis and coronary mortality (Wing et al., 1991, Lloyd et al., 1996, Rosmond and Björntorp, 1998, Raikkonen et al., 1999 and Chen et al., 2001) such as high WHR (Pereira et al., 2000), increased high-density lipoproteins to low-density lipoproteins ratio (HDL/LDL ratio) (Schwertner and Fischer, 2000), and increased serum levels of triglycerides (Austin et al., 1991, LaRosa, 1997, Gotto, 1998 and Cullen, 2000).
With respect specifically to social anxiety, however, studies of cardiovascular functioning are scant, and to the best of our knowledge, no previous study has explored the relationship between social anxiety and metabolic and anthropometric risk factors. To fill this gap, we set out to explore this relationship in a population-based cohort of women who were all 41–42 years old. Women endorsing social anxiety were compared with those who did not, with respect to waist-to-hip ratio (WHR) and body mass index (BMI), serum lipids, and a number of hormones known to influence WHR and/or serum lipids. For comparison, we also stratified the cohort by whether or not they endorsed anxiety attacks, depressed mood, bulimia nervosa, obsessive-compulsive symptoms, or premenstrual dysphoria.
