Panic attacks associated with increased risk of cardiovascular events and death in older women

October 01, 2007

Older women who experience at least one full-blown panic attack may have an increased risk of having a heart attack or stroke and an increased risk of death in the next five years, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Panic attacks involve the sudden development of fear, anxiety or extreme discomfort accompanied by four or more additional symptoms, according to background information in the article. They may occur sporadically or as part of an anxiety disorder, such as panic disorder, social anxiety disorder or phobias.

Jordan W. Smoller, M.D., Sc.D., of Massachusetts General Hospital, Boston, and colleagues studied 3,369 healthy postmenopausal women (age 51 to 83, average age 65.9). When they entered the study between 1997 and 2000, the women filled out a questionnaire about the occurrence of panic attacks in the previous six months. They were then followed for an average of 5.3 years to see whether they had a heart attack or stroke or died from any cause.

About 10 percent of the women reported having a full-blown panic attack in the six months prior to the study. After the researchers adjusted for other cardiovascular risk factors, having one or more panic attacks was associated with four times the risk of myocardial infarction (heart attack), three times the risk of having a heart attack or stroke and nearly twice the risk of death from any cause. These associations remained after controlling for depression, suggesting that panic attacks may be a separate, independent risk factor for cardiovascular events.

The results add panic attacks to the list of emotions and psychiatric symptoms that have already been linked to cardiovascular risk, including depression, anger and hostility, the authors note. Panic attacks could be associated with other cardiovascular risk factors, such as hypertension. Alternatively, anxiety could contribute to adverse cardiovascular effects, such as coronary artery spasm, tendency toward increased blood clotting or disturbances in heart rhythm.

"These results suggest that panic anxiety is a marker for increased risk of cardiovascular morbidity and mortality among postmenopausal women," the authors conclude. "Future studies are needed to clarify the causal connection, if any, between panic attacks and cardiovascular events. Our results imply, however, that older women with a recent history of panic attacks represent a subgroup at elevated risk of myocardial infarction and stroke in whom careful monitoring and cardiovascular risk reduction may be particularly important."
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(Arch Gen Psychiatry. 2007;64(10):1153-1160. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: The Women's Health Initiative program is funded by the National Heart, Lung and Blood Institute, U.S. Department of Health and Human Services. The Myocardial Ischemia and Migraine Study was funded by Glaxo Wellcome (now GlaxoSmithKline). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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