Anxiety and peripheral artery disease

This review pooled past findings on the prevalence and impact of anxiety among patients with peripheral artery disease (PAD). Past studies have mainly assessed anxiety symptoms using questionnaires, with a pooled analysis of 10 studies suggesting anxiety symptoms to be present in 38% of patients with PAD. An analysis of US hospital admission data suggested that the prevalence of a prior diagnosis of anxiety disorder had doubled between 2011 and 2017 in patients undergoing revascularisation to treat PAD. Risk factors identified more frequently among PAD patients with anxiety symptoms included female sex, financial concerns and lack of social support. Anxiety symptoms have also been associated with worse health-related quality of life, more severe leg pain and poor walking ability. Although the long-term impact of anxiety symptoms on PAD outcomes is largely unexplored, one study reported that perceived chronic stress, which is common in anxious patients, was associated with a two-fold increased risk of death. Anxiety symptoms are associated with activation of the hypothalamus-pituitary-adrenal axis and systemic inflammation, which could potentially contribute to excess adverse event risk among PAD patients. Anxiety is frequently observed around the time of surgery, with one randomised trial reporting reduced anxiety symptoms while listening to classical music during revascularisation. Exercise therapy has also been reported to reduce anxiety symptoms in some trials. In conclusion, anxiety symptoms are frequently observed in PAD patients and associated with poor health status. Future research is needed to clarify the association of anxiety symptoms with long-term outcomes and to identify effective interventions to limit anxiety symptoms among PAD patients.