Panic Attacks May Hike Heart Disease Risk in Women

Study of postmenopausal women finds association, but no direct cause and effect

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By
HealthDay Reporter

TUESDAY, Oct. 2, 2007 (HealthDay News) -- Postmenopausal women who've had at least one panic attack may be at greater risk for heart disease, stroke and even death, new research suggests.

The study found that older women with a history of panic attacks were four times more likely to have heart disease than women who hadn't had a panic attack.

"Women who reported at least one panic attack were at higher risk of having cardiovascular illness and death after an average of five years of follow-up. Even after controlling for other risk factors, a panic attack remained an independent risk factor on its own," said study author Dr. Jordan Smoller, an associate professor of psychiatry at Harvard Medical School.

Symptoms of a panic attack include a sudden feeling of fear, anxiety or extreme discomfort that's out of proportion to your current situation. Panic attacks may also be accompanied by a rapid or irregular heartbeat, sweating, hot flashes, chills, chest pain, difficulty breathing, shaking, dizziness and a feeling that you might die. About one in 10 postmenopausal women has had at least one panic attack, according to the study.

The research, published in the October issue of the Archives of General Psychiatry, included 3,369 postmenopausal women between the ages of 51 and 83. All of the women completed questionnaires about the occurrence of panic attacks in the previous six months. A full-blown panic attack was one in which sudden fear was accompanied by at least four other panic attack symptoms. A limited panic attack was one in which fear was accompanied by one to three additional symptoms.

After an average 5.3 years of follow-up, the researchers collected information on heart disease, stroke and death from any cause. The researchers also adjusted the data to account for other known cardiovascular disease risk factors, such as weight, alcohol use, hormone use, high cholesterol, high blood pressure, age, diabetes and smoking history.

After adjusting for all those factors, the researchers found that full-blown panic attacks were associated with a fourfold higher risk of heart disease, nearly twice the risk of stroke, and a 75 percent increase in risk of death from any cause, compared to women who'd experienced no panic attacks. Women who'd had limited panic attacks fared somewhat better. The adjusted risk of heart disease was 65 percent higher, stroke risk was more than doubled, and all-cause mortality was increased by 34 percent.

"Negative emotional states and psychiatric symptoms can be related to adverse medical outcomes," said Smoller, who's also assistant vice chairman of the department of psychiatry at Massachusetts General Hospital.

"Panic attacks may be having a direct effect on cardiovascular health -- anxiety, panic and other negative emotional states have been related to changes in heart rhythm and changes in cardiac blood flow in previous studies. It may be that stress hormones and other components of the 'fight-or-flight' reactions that accompany panic directly impact the cardiovascular system," he said.

"Or," he added, "it could be that panic attacks are simply a marker for increased risk that is due to something other than the panic attacks themselves. It might be that the women who were experiencing panic might have been experiencing some other unrecognized cardiovascular problem."

Dr. Stephen Siegel, a cardiologist at New York University Medical Center, said the study definitely raises some interesting questions, but more research needs to be done to establish a definite link between panic attacks and cardiovascular health.

In the meantime, Siegel recommended that all women do whatever they can to reduce their cardiovascular disease risk factors. "Control all the known risk factors out there -- hypertension, cigarette smoking, diabetes, elevated cholesterol. We can make changes in these factors and we know they make a difference," he said.

Exercise is another great -- and proven -- option, Siegel said. Not only does it improve your heart health by lowering blood sugar, blood pressure and cholesterol, but exercise can also help ease anxiety and depression, providing both a physical and psychological benefit.

More information

To learn more about panic attacks and panic disorder, visit the American Psychological Association.

SOURCES: Jordan Smoller, M.D., associate professor, psychiatry, Harvard Medical School, and assistant vice chairman, department of psychiatry, Massachusetts General Hospital, Boston; Stephen Siegel, M.D., cardiologist, New York University Medical Center, and clinical assistant professor, New York University School of Medicine, New York City; October 2007 Archives of General Psychiatry

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