Panic attacks, cardiovascular risks linked in older women

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Panic attacks may be an independent risk factor for cardiovascular events in older women, according to study in the October issue of the Archives of General Psychiatry.

Jordan Smoller, MD, of Massachusetts General Hospital and colleagues examined 3,369 healthy postmenopausal women (ages 51 to 83) from 10 clinical centers in the Greater Boston area. Between 1997 and 2000, they enrolled in a myocardial ischemia and migraine study, and completed a questionnaire about panic attacks in the previous six months.

Among them, 9.7 percent reported having had at least one full-blown panic attack, as defined by four or more cognitive or autonomic symptoms from a 12-symptom checklist, in the six months prior to baseline. Another 8.1 percent reported a limited-symptom panic attack with one to three rather than at least four symptoms.

After an average of 5.3 years of follow up, full-blown panic attacks were significantly associated with cardiovascular events whereas limited-symptom attacks showed weaker, less significant effects.

After controlling for body mass index, smoking, hypertension, depression, diabetes, history of heart disease, and other factors, full-blown panic attacks were associated with:

  • Coronary heart disease with a hazard ratio (HR) of 4.2;
  • Combined end point of coronary heart disease and stroke with a HR of 3.08; and 
  • All-cause mortality with a HR 1.75.

Excluding the 149 women with a history of cardiovascular disease yielded similar hazard ratios, which is 3.5 for coronary heart disease.

The study concluded that panic attacks are common among and linked to an independent risk factor for cardiovascular morbidity and mortality in postmenopausal women.