Panic plaques: panic disorder & coronary artery disease in patients with chest pain
1Department of Family and Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. katerndahl@uthscsa.edu
Insights
Panic disorder is linked to chest pain and cardiovascular risk factors. Recurrent panic attacks may even cause coronary artery disease (CAD), suggesting physicians consider both conditions.
Area of Science:
- Cardiology
- Psychiatry
- Epidemiology
Background:
- Chest pain is a common symptom with various causes.
- Panic disorder is a psychiatric condition characterized by sudden episodes of intense fear.
- The relationship between panic disorder and cardiovascular health requires further investigation.
Purpose of the Study:
- To identify chest pain characteristics associated with panic disorder.
- To determine the association between panic disorder and coronary artery disease (CAD).
- To assess the link between panic disorder and cardiovascular risk factors.
Main Methods:
- Systematic review of studies identified through MEDLINE and PSYCINFO databases.
- Inclusion of case-control and cohort studies using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for panic disorder.
- Utilized MeSH headings related to panic disorder, chest pain, CAD, and cardiovascular risk factors.
Main Results:
- A relative risk of 2.03 for panic disorder in patients with nonanginal chest pain.
- Studies in emergency departments showed a relative risk of 1.25 for panic disorder and CAD.
- Panic disorder is linked to cardiac risk factors, with an inverse relationship observed between CAD and panic disorder prevalence in some studies.
Conclusions:
- Panic disorder and CAD are correlated, particularly in noncardiology settings.
- Recurrent panic attacks may contribute to the development of CAD.
- Clinicians should consider screening for panic disorder in patients with chest pain and vice versa.
Background:
The purpose of this systematic review was to identify characteristics of the chest pain associated with the presence of panic disorder, to determine the strength of the association between panic disorder and coronary artery disease (CAD), and to determine the association between panic disorder and known cardiovascular risk factors.
Methods:
Potential studies were identified via computerized search using MEDLINE and PSYCINFO databases, and review of bibliographies. MeSH headings used included "panic disorder" with "chest pain," "panic disorder" with "coronary disease or cardiovascular disorders or heart disorders," and "panic disorder" with "cholesterol or essential hypertension or tobacco smoking." Studies had to base their diagnosis of panic disorder on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, and objective criteria of CAD and risk factors had to be used. Only case-control and cohort studies were included.
Results:
The relative risk of panic disorder in patients with nonanginal chest pain is 2.03 [confidence interval (CI), 1.41 to 2.92]. Concerning the relationship between panic disorder and CAD, studies conducted in emergency departments found a relative risk of 1.25 (CI, 0.87 to 1.80). However, there is an inverse relationship between the prevalence of CAD in the study and the prevalence of panic disorder among the patients with CAD (r = -.469, P =.086). Panic disorder has also been linked to cardiac risk factors.
Conclusions:
Panic disorder and CAD are correlated in noncardiology settings, and recurrent panic attacks may actually cause CAD. Recognition of either condition should lead the family physician to consider the other, resulting in increased vigilance and possible screening.
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