Postmenopausal women who have 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 Jordan Smoller, MD, an associate professor of psychiatry at Harvard Medical School.


Panic attack symptoms 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 heartbeat, sweating, chest pain, difficulty breathing, shaking, dizziness and a feeling that you might die.

Approximately one in 10 postmenopausal women has had at least one panic attack, ac cording to the study.

The Study

The research, published in 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 53 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 for heart disease, nearly twice the risk for stroke,

and a 75% increase in risk for 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 for heart disease was 65% higher, stroke risk was more than doubled, and all-cause mortality was increased by 34%.


"Negative emotional states and psychiatric symptoms can be related to adverse medical outcomes," said Dr. Smoller, who is 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.

Expert Recommendations

Stephen Siegel, MD, 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, Dr. 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," he said.

Exercise is another great—and proven—option, Dr. 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.

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