Fear of terror may raise heart disease risk

Israeli women who are extremely afraid of terrorism appear to have higher levels of a marker of blood vessel inflammation, a sign they may be at risk of cardiovascular disease, researchers report.

The investigators found that women who said they were particularly afraid of attacks such as suicide bombings were 70 percent more likely to have high levels of C-reactive protein (CRP), linked in several studies to an increased risk of heart attack, stroke, sudden cardiac death and artery disease, among other conditions.

"This study demonstrates for the first time, in a sample of apparently healthy workers, that the psychological reaction of chronic fear of terror has a negative impact on health in women," Dr. Samuel Melamed of Tel-Aviv University in Israel and colleagues write in the medical journal Psychosomatic Medicine.

"International studies are needed to explore the extent of fear of terror in other countries, and the relative risk of physical morbidity in women," they add.

This is not the first study to link mental state to inflammation. Previous research has shown that repeated episodes of acute or chronic stress can culminate in chronic inflammation, leading to cardiovascular disease.

To investigate whether the same pattern occurs in people living under the threat of random acts of violence, Melamed and his team surveyed 1152 healthy, employed adults living in Israel, which "has been subject to a continuous threat of terror" since September 2000.

The investigators asked the participants if they had a deep concern for their personal safety, whether they got particularly nervous in crowded places, and if they were very afraid that an attack will hurt themselves or their families.

The authors found that women tended to have more fears related to terrorism than men. More than 26 percent of women exhibited a high state of fear, most of them for at least one year, compared with 11 percent of men.

Women who reported a high fear of terrorism were more likely to have high levels of CRP, even after removing the influence of general anxiety, depression and other factors that can influence CRP.

Men's fears appeared to have no relationship to their levels of CRP.

These gender differences appear consistent with previous research, Melamed and his colleagues write, which has also shown that women show more signs of depression, post-traumatic stress disorder (PTSD), and other mental health problems after a terrorist attack than men.

SOURCE: Psychosomatic Medicine, July/August 2004.