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Panic Attack V Heart Attack

Monday, December 15th, 2008 Panic Attack V Heart Attack

It has been disclosed that those suffering from panic attacks are at greater risk from heart attack in later life, according to a Jenny Hope article in the Mail (11 12 08). However an article in the Telegraph say that people who suffer panic attacks are a third more likely to have a heart attack,

Furthermore for those diagnosed with panic disorder before the age of 50, the news is somewhat gloomy. There is a likelihood you will be more at risk to a heart disease in later life. The significance for researchers is that the findings are important because those people who have panic attacks often fear they are in the grip of a heart attack, and there may in fact be a biological link.

Interestingly, research also found that the risk of dying from coronary heart disease (CHD) was lower among people suffering panic attacks compared with the normal population. The study looked at 57, 615 UK patients who had been diagnosed as having panic attacks. It found that those under 50 years of age were 38% more likely to suffer a heart attack than similar patients who did not have panic attacks. There was no significant difference in risk in older age groups.

However, the risk of dying from heart disease for panic attack sufferers was 24% less than among non-sufferers, possibly because they saw their doctor more often.

As the researchers acknowledge, the design and limitations of this study need to be considered when interpreting its results. While it may be that panic attacks and heart problems are linked in some way, these results might arise from heart problems being misdiagnosed as panic attacks.

The Medical Research Council (MRC) funded the research and it was carried out by Dr Kate Walters and colleagues from University College London. It was a cohort study and investigated the risk of coronary heart disease (CHD), heart attack and deaths from heart disease in patients with panic attacks or panic disorder. For people aged over 50, there was an increased risk of heart disease of 11 per cent. However, the risk of death from heart disease in adults with panic attacks was cut by a quarter compared with the normal population.

Dr Walters said the reduced risk of death might be explained by the lower level of heart-related deaths in younger people. ‘Or it might be because people with panic disorders go to their doctors earlier and more frequently and, therefore, are more likely to have their heart disease identified and treated early, thus reducing the likelihood of dying from it,’ she said. She stressed that panic attack sufferers should not be overly concerned but consult their doctors.

‘While there is a small increased risk among people diagnosed by their GP with panic attacks, the vast majority of people will not go on to have a heart attack or heart diseases,’ she added.

The researchers selected adults older than 16 years with panic attacks (or panic disorder) who were entered into the GPDR between 1990 and 2002: a total of 57,615 people. People with a previous recorded diagnosis of heart disease or panic disorder prior to entry into the study were excluded, as were patients who had less than six months of reliable medical records.

These patients were matched to a random sample of 347,039 people who had no record of either condition. For each case, they chose six patients of the same sex and age group (in 10-year bands) who had been registered for the study at about the same time. The researchers followed everyone until the end of the study or until they left their GP’s practice, to identify those who developed CHD, had a new heart attack or died from heart disease (CHD-related).

Researchers adjusted for age, sex, deprivation, heart disease risk factors (such as smoking and blood pressure), psychiatric conditions and the number of prescribed medication. This was to ensure no other factors influenced the study. However, it is important as indicated by the researchers that results should be evaluated from a cautionary point of view, particularly as they were unable to adjust for the fact that some GPs might tend to under-report both heart disease and panic disorder, and that this could have influenced the link.

Finally, one could argue both the merits and drawbacks in terms of this research. Generally, this study had several advantages as a result of being large and assessing outcomes after the diagnosis of panic attack. This means it is possible to have greater certainty that people were not simply panicking because they already knew or had just found out that they had heart disease.

Notably, the limitations acknowledged by the researchers and the observational nature of the study mean that it is not possible yet to be sure if there was any clinical misdiagnosis of heart disease as panic attacks.

In conclusion further observational studies will be required.

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