Enhanced stress reactivity in paediatric anxiety disorders: Implications for future cardiovascular health

Catherine Monk, Pavel Kovelenko, Lauren M. Ellman, Richard P. Sloan, Emilia Bagiella, Jack M. Gorman, Daniel S. Pine

Research output: Contribution to journalArticlepeer-review

98 Scopus citations


The aim was to clarify the developmental nature of associations between psychiatric illness and risk for cardiovascular disease by investigating differences in cardiac functioning between youth with anxiety disorders and healthy controls. Twenty-two children meeting DSM-IV criteria for either separation anxiety disorder, overanxious disorder, panic disorder/panic attacks, or social phobia and 12 healthy controls underwent continuous electrocardiogram and respiration rate monitoring during a 15 min baseline period and 15 min of exposure to 5% CO2. Heart rate (HR) and high frequency heart rate variability (HRV), a non-invasive measure of cardiac parasympathetic control, were calculated. Youth with anxiety disorders had higher and less fluctuating HR during baseline. Data also suggested that probands showed diminished overall changes in HRV during baseline and CO2 inhalation relative to controls. However, as respiration rate affects HRV, these findings were confounded by changes in respiration elicited by CO2 inhalation. The data suggest that youth with anxiety disorders experience an elevated and less fluctuating HR in the face of a novel situation, possibly due to a failure to appropriately modulate HRV. In adults, sustained elevations in HR in conjunction with deficient vagal modulation predicts risk for future cardiovascular disease. As such, the current data suggest that the presence of an anxiety disorder may identify youth who exhibit autonomic profiles that place them at risk for cardiac disease.

Original languageEnglish
Pages (from-to)199-206
Number of pages8
JournalInternational Journal of Neuropsychopharmacology
Issue number2
StatePublished - 2001
Externally publishedYes


  • Cardiovascular disease
  • Heart rate
  • Heart rate variability
  • Paediatric anxiety disorders
  • Stress


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