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Heart disease patients may be at higher risk of heart attacks, strokes, heart failure and death if they suffer from anxiety too, a US journal report says.

In a study of more than 1,000 people with heart disease, researchers noted a 74% increased risk of cardiovascular events in those with an anxiety disorder.

The study appeared in Archives of General Psychiatry.

More research is needed to understand the link, say British experts.

Researchers from Tilburg University in the Netherlands followed up the group of patients after an average of five and a half years.

They found that the yearly rate of cardiovascular events was 9.6% in the 106 patients who suffered from a general anxiety disorder.

In the 909 patients without an anxiety disorder, the rate was 6.6%.

As many as 24% to 31% of heart disease patients also have symptoms of anxiety, says the study.

Yet few studies have looked into the role of anxiety in predicting cardiovascular problems like heart attacks, strokes and even heart failure and death.

The authors of the study say the question of why anxiety disorders are linked to increased risk in patients with coronary heart disease is still not clear.

It could be that patients with anxiety are more likely to go and see their doctor when they have symptoms and therefore are more likely to receive a diagnosis of stroke or heart attack.

On the other hand, patients with higher anxiety levels might be less likely to visit their specialist and then be at increased risk of cardiovascular problems.

It is also possible, the study says, that there is a common underlying factor which makes individuals susceptible to both heart disease and anxiety.

Dr Elisabeth Martens, expert in neuropsychology at Tilburg University and lead author, said that the findings have implications for clinical practice and research.

"Evaluation and treatment of anxiety may also be considered as part of the comprehensive management of patients with coronary heart disease," she said.

Judy O'Sullivan, senior cardiac nurse at the British Heart Foundation, said: "The association between poor mental health and coronary heart disease is very complex and still not fully understood."

She added: "We know that people with heart disease are often anxious about their future and about how their lives, and the lives of those closest to them, will be affected by the disease.

"Now we need to spend more time and money understanding the links between poor mental health and heart disease."