Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database

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Abstract
To determine the risk of coronary heart disease (CHD), acute myocardial infarction (MI), and CHD-related mortality in patients with panic attacks/disorder. We conducted a cohort study using 650 practices in the ‘General Practice Research Database’. We selected all 57 615 adults diagnosed with panic attacks/disorder and a random sample of 347 039 unexposed, frequency matched for sex/age, and measured incidence of CHD, MI, and CHD-related mortality rate. There was a significantly higher incidence of MI following new onset panic in people under 50 years of age, but not in older age groups. There was a higher incidence of CHD for all ages, more marked in those under 50 years, but no significant differences in CHD mortality. Fully adjusted models showed panic attacks/disorder were associated with a significantly increased hazard of MI in those under 50 years (HR 1.38, 95% CI 1.06–1.79) and CHD at all ages (<50 years, HR 1.44, 95% CI 1.25–1.65; ≥50 years, HR 1.11, 95% CI 1.03–1.20), but no increased hazard of MI over 50 years (HR 0.92, 95% CI 0.82–1.03), and a slightly reduced CHD-mortality at all ages (HR 0.76, 95% CI 0.66–0.88). New onset panic attacks/disorder were associated with increased hazard of subsequent CHD/MI diagnosis in younger people, but with less effect in people over 50, and a slightly reduced hazard of CHD-related mortality. This may be due to initial misdiagnosis of CHD as panic attacks or an underlying increased risk of CHD with panic attacks/disorder in younger people.

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