Panic Attacks Linked to Increased Coronary Heart Disease

New panic attacks or disorders are linked to an increased risk for subsequent coronary heart disease (CHD) and myocardial infarction (MI) in younger people, according to the results of a new study.

“The complex relationship between the ‘heart’ and the ‘mind’ has been a subject of much recent debate,” write Kate Walters, from the Department of Primary Care & Population Sciences, University College London, United Kingdom. “Most of this has focused on the relationship between depression and…CHD and relatively little large-scale research has considered anxiety disorders. Less is known about the relationship of panic disorder with cardiac disease.”

The goal of this cohort study was to determine the risk for CHD, acute MI, and CHD-related mortality in patients with panic attacks or disorder, using 650 practices.

Incidences of CHD, MI, and CHD-related mortality rate in 57,615 adults diagnosed with panic attacks or disorder were compared vs those from a random sample of 347,039 control subjects who were frequency matched for sex and age. In people younger than 50 years, but not in older-age groups, there was a significantly higher incidence of MI after a new-onset panic attack or disorder. For all ages, there was a higher incidence of CHD in those with panic attacks or disorder, and these were more marked in those younger than 50 years. However, there were no significant differences in CHD mortality rates.
Panic attacks or disorders were associated with a significantly increased hazard of MI in those younger than 50 years and of CHD at all ages, based on fully adjusted models. However, there was no increased hazard of MI in patients older than 50 years, and CHD-related mortality rate was slightly decreased at all ages.

“New onset panic attacks/disorder were associated with increased hazard of subsequent CHD/MI diagnosis in younger people, but with less effect in people over 50, and a slightly reduced hazard of CHD-related mortality,” the study authors write. “This may be due to initial misdiagnosis of CHD as panic attacks or an underlying increased risk of CHD with panic attacks/disorder in younger people.”

“The increased hazard of CHD and acute MI is higher in younger people presenting with panic,” the study authors conclude. “Clinicians may be more cautious about excluding CHD when making initial panic diagnoses in older people, and therefore have a lower rate of initial misdiagnosis of CHD as panic. Alternatively it may be that small increases in atherogenesis caused by sympathetic nervous system activation in panic disorder are overtaken by a more dominant underlying age-related atherogenesis in older people, thus masking the relative risk attributed to panic in older age groups.”

Context: Panic attacks not reaching full criteria for panic disorder have a prevalence of 1.9% in the general population, 5.6% to 9.2% in primary care practices, and 10% to 53% in cardiology departments. They are associated with substantial morbidity, and a 2-fold increase in the risk for CHD has been reported in those with panic disorder.

Practice Pearls:

• Panic attack or disorder is associated with a higher incidence of MI in patients younger than 50 years, especially in women.
• Panic attack or disorder is associated with an increased rate of CHD but not an increased rate of CHD-related mortality.

Eur Heart J. 2008;29:2981-2988. Dec. 2, 2008