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Study Links Panic Disorder With Increased Risk of Heart Disease

Who's at Risk?

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Updated May 04, 2009

British researchers conducted a study to determine the risk of coronary heart disease (CHD), acute myocardial infarction (heart attack), and CHD-related deaths in patients with panic attacks or panic disorder. This study analyzed and tracked medical records of participants from 1990 to 2002.

The Participants

Using data from a large database of medical records from general practitioner practices in the United Kingdom (the General Practice Research Database or GPRD), British researchers conducted a study of 57,615 adults with a diagnosis of panic attacks or panic disorder. The study also included a sample of 347,000 participants without panic symptoms. The average age of the participants was 43 years old and 73% were female.

The Results

The study found that:

  • Heart disease was more prevalent among all study participants with newly diagnosed panic disorder or panic attacks.

  • Heart disease among study participants with panic symptoms was especially high among participants under age 50.

  • Female study participants between the ages of 16 and 40 years with new onset panic symptoms had a higher incidence of having a heart attack.

  • There was no increased incidence of heart attack for those over age 50 with panic disorder.

  • Although the incidence of heart disease and heart attack was especially high for younger study participants with panic symptoms, cardiac-related death rates were lower for all age groups with panic.

The Conclusions

Like many studies of its kind, the conclusions the researchers present are not definitive. The exact reason for the increase in CHD and heart attack in the study group was not determined. However, the researchers offered the following suggestions of a causal link:

  1. The increased incidence of heart disease may be the result of psychological strain, which has been linked to CHD.

  2. Some studies show that heart rate variability (normal fluctuations between heart beats) is reduced in those with anxiety and panic symptoms. Reduced heart rate variability has been implicated as a risk factor for heart disease.

  3. Hyperventilation that occurs with panic attacks can trigger a coronary artery spasm, leading to an acute cardiac event (a heart attack or heart rhythm abnormality).

  4. Possible secretion of certain stress hormones and increased cardiac activity during panic attacks may be a pre-disposing factor in ventricular arrhythmias.

The researchers also discussed potential study limitations that may have affected their results. They identify these study limitations as:

  1. Limited information was available on certain variables, including individual measures of economic status and ethnicity. The researchers also note incomplete records of some data, for example smoking, among the study participants.

  2. The findings may be partly explained by the diagnostic abilities and interpretations of the various doctors who made the diagnoses of the study participants. For example, some doctors may tend to under-report heart disease and panic disorder in comparison to others.

  3. The diagnosis of panic attacks/disorder in the General Practice Research Database used for this study had not been validated.

Implications of the Study

The researchers suggest that those with panic disorder or a history of panic attacks be appropriately screened for heart disease. However, they also note that their results should be “interpreted with caution” and state:

Well-designed prospective research is needed to establish whether panic disorder is an independent risk factor for the development of CHD.

Source:

Walters, Kate; Rait, Greta; Petersen, Irene; Williams, Rachael; and Nazareth, Irwin. Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database. European Heart Journal 2008; 29(24):2981-2988.

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