WebMD Medical News
Louise Chang, MD
Oct. 1, 2007 -- Older women who experience panic attacks appear to have an
increased risk for having heart attacks or heart-related death, new research
Postmenopausal women in the study who reported at least one full-blown panic
attack within six months of being interviewed were four times as likely as
other older women to have a heart attack or related death
over the next five years.
They were three times as likely to have either a heart attack, heart-related
death, or stroke, and nearly twice as
likely to die from any cause.
Earlier studies have implicated depression as a risk factor for
heart disease, but the new
research is the first to suggest a direct link between anxiety-related panic attacks
and heart attack and stroke risk.
Harvard Medical School associate professor of psychiatry Jordan W. Smoller,
MD, ScD, who led the study team, says more research is needed to confirm the
"There is not a lot of previous evidence suggesting that panic attacks
are in themselves dangerous (in terms of heart risk)," he tells WebMD.
"Our study does not resolve the question. But it does suggest that older
women with a recent history of panic attacks may warrant closer scrutiny for
The study included 3,369 healthy postmenopausal women participating in the
larger ongoing Women's Health Initiative (WHI) trial examining risk factors for
heart disease and other health outcomes among older women.
When they entered the study between 1997 and 2000, the women, whose average
age was 66, were asked if they had recently experienced a panic attack. They
were then followed for an average of 5.3 years.
At enrollment, one out of 10 women reported having had a full-blown panic
attack within six months.
After adjusting for the impact of other established cardiovascular risk
factors, a recent panic attack was associated with a fourfold increased risk of
heart attack or heart-related death and a twofold increase in death from any
The findings are published in the October issue of the journal Archives
of General Psychiatry. The
research was funded by Glaxo Wellcome, now the pharmaceutical company
"Our study adds panic attacks to the list of emotional states and
psychiatric symptoms that have been linked
to excess risk of cardiovascular disease and death," the researchers
Smoller says it is not clear if the anxiety that leads to panic attacks
directly increases cardiovascular risk or if panic attacks are actually a
symptom of undiagnosed heart and vascular disease.
"Shortness of breath, chest pain, and raised
heartbeat are all symptoms of panic attack," he says. "It is possible
that some women who reported these symptoms might have unrecognized cardiac
It is also not clear if the findings apply to younger women and men, or if
aggressive treatment of panic attacks with antianxiety drugs lowers heart attack and
Cardiologist Gerald F. Fletcher, MD, tells WebMD that while there is growing
evidence to suggest that depression, anxiety, and other psychological
conditions have an adverse impact on the heart, the impact remains difficult to
Fletcher is a professor of medicine at the Mayo Clinic Jacksonville and a
spokesman for the American Heart Association.
"We have been able to show a direct link between heart disease and risk
factors like hypertension, cholesterol, obesity, and smoking," he says.
"These are easily measurable, but the impact of depression and anxiety on
heart risk is not."
SOURCES: Smoller, J.W., Archives of General Psychiatry, October 2007;
vol 64: pp 1153-1161. Jordan W. Smoller, MD, ScD, associate professor of
psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston.
Gerald F. Fletcher, MD, professor of medicine, division of cardiovascular
diseases, Mayo Clinic Jacksonville, Jacksonville, Fla.
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