Anxiety Disorders and Medication Adherence in Cardiovascular Disease: Systematic Review & Meta-Analysis

Overview

This systematic review and meta-analysis evaluated the association between anxiety disorders and medication adherence in adults with cardiovascular disease (CVD). Findings suggest that anxiety is linked to poorer adherence to cardiovascular medications, which may contribute to adverse cardiovascular outcomes.

Background

Cardiovascular diseases are the leading cause of global mortality, accounting for approximately one-third of deaths worldwide. Pharmacological treatment is essential for managing CVD and reducing mortality, but its effectiveness depends heavily on patient adherence. Psychological factors, particularly anxiety disorders, are prevalent among CVD patients and may impair medication adherence, thereby worsening clinical outcomes. Despite extensive research on depression and adherence, the specific impact of anxiety disorders on cardiovascular medication compliance remains underexplored.

Data Highlights

The review included observational studies assessing anxiety disorders via clinical diagnosis or validated questionnaires and their relationship with medication adherence in adults with cardiovascular disease. The search spanned five major databases up to March 2025, following PRISMA guidelines. Key terms combined adherence, anxiety disorders, cardiovascular diseases, and cohort study designs. The analysis aimed to quantify the effect size of anxiety on adherence and explore subgroup differences by disease type, assessment tools, and geographic regions.

Key Findings

• Anxiety disorders are commonly observed in patients with cardiovascular disease and are associated with increased morbidity and mortality.
• Anxiety negatively impacts cognitive focus, energy, and motivation, which may reduce patients’ ability and willingness to adhere to prescribed cardiovascular medications.
• There is a significant inverse relationship between anxiety presence and medication adherence among cardiovascular patients.
• Improved medication adherence is linked to reduced cardiovascular events and mortality, highlighting the clinical importance of addressing anxiety.
• Previous literature has focused primarily on depression; this review fills a gap by systematically analyzing anxiety’s role in medication non-adherence in cardiovascular disease.

Clinical Implications

Clinicians should routinely assess anxiety disorders in patients with cardiovascular disease as part of comprehensive care. Addressing anxiety through appropriate interventions may improve medication adherence, thereby reducing cardiovascular events and mortality. Integrating mental health support into cardiovascular disease management could enhance overall treatment effectiveness.

Conclusion

Anxiety disorders significantly contribute to medication non-adherence in cardiovascular disease patients, potentially worsening clinical outcomes. Targeted strategies to identify and manage anxiety may improve adherence and reduce cardiovascular risk.

References

1. World Health Organization 2021 -- Cardiovascular Diseases Global Mortality Data
2. Chen et al. -- Real-world Evidence on Medication Adherence and Cardiovascular Outcomes
3. Poletti et al. -- Depression and Medication Adherence in Chronic Heart Failure