Research links panic and heart attack in older women

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Heart attack risk rises four times for panic victims

New research has linked panic attacks in older women with an increased risk of heart attack, stroke, and death from all causes, adding panic attacks to the growing list of mental and emotional conditions with potentially deadly physical effects.

A study of more than 3,300 women ages 51 to 83 indicated that panic attacks were relatively common, suffered by about 10 percent of those in the study. While heart attacks and strokes were relatively rare, those suffering panic attacks had four times the risk of heart attack, three times the risk of heart attack or stroke, and twice the risk of dying from any cause as those who didn’t.

“This adds panic attacks to the growing body of evidence that emotional states and psychological symptoms are relevant to physical outcomes,” said Jordan Smoller, associate professor of psychiatry at Harvard Medical School and Massachusetts General Hospital (MGH), associate professor of epidemiology at the Harvard School of Public Health, and the study’s lead author.

Smoller said the link between panic attack and health remains unclear. The study controlled for 14 known variables, including age, race, income, body mass index, alcohol consumption, smoking, hormone use, high cholesterol or blood pressure, level of physical activity, atrial fibrillation, depression, and history of diabetes or cardiovascular disease.

A panic attack’s influence on health appears to be independent of any of those factors, Smoller said. That doesn’t rule out, however, some other unknown underlying condition at work, causing both panic attacks and increased health risks.

Panic attacks differ from other anxiety-related conditions in intensity and duration. A panic attack tends to occur suddenly and be brief. It is marked by several symptoms, including feelings of terror, sweating, rapid heartbeat, and shortness of breath, among others.

The research, published in the October Archives of General Psychiatry, was conducted as part of the Myocardial Ischemia and Migrane Study. The study included 3,369 healthy postmenopausal women, enrolled between 1997 and 2000 and followed for an average of 5.3 years. It was conducted by Smoller with Professor of Psychiatry Mark Pollack at MGH and colleagues from the Albert Einstein College of Medicine, Ohio State University, the University of Alabama, Birmingham, the University of California, Irvine, and the University of Florida and Malcolm Randall Veterans Affairs Medical Center.

On enrollment, the women were asked whether they’d had a panic attack in the prior six months and then were followed for the study’s course. While just 1.1 percent of nonpanic attack sufferers had heart attacks during the study, that rose to 3.9 percent for those who did have panic attacks.

The numbers are similar for stroke, with just 1.1 percent of those who didn’t have a panic attack suffering strokes, compared with 3.6 percent of panic attack sufferers.

The study helps fill in the emerging picture of the effects of emotional states on one’s physical health. Earlier work has linked phobias, anger, depression, and hostility to cardiovascular risk.

Smoller said there are many questions remaining. Because the questionnaire used to enroll women in the study didn’t differentiate between those who’d had only one panic attack and those who’d experienced regular, recurring attacks, there’s no way to know whether those groups experienced different outcomes. Similarly, he said, the study doesn’t examine whether treating panic attacks can have a beneficial impact on one’s cardiac health.