Key result
Postmenopausal women with a recent history of panic attacks had a higher likelihood of experiencing chest pain during 24-hour AECG monitoring (OR 2.01; 95% CI 1.40-2.88) compared to those without.
Why the study?
Is a recent history of panic attacks associated with daily life ischemia, chest pain, and altered heart rate variability in postmenopausal women?
Cross-Sectional (n=3,063)
Yes
Is a recent history of panic attacks associated with daily life ischemia, chest pain, and altered heart rate variability in postmenopausal women?
Effect estimate: OR 2.01 (95% CI 1.40-2.88)
In postmenopausal women, a recent history of panic attacks is associated with increased episodes of chest pain, including ischemic chest pain, but not with an overall increase in daily life ischemia.
Panic history may account for chest pain in postmenopausal women without raising overall ischemia; leaves open causal and HRV links for prospective study.
Background: Chest pain is a common symptom of panic attacks, but little is known about the relationship in older women among panic attacks, chest pain, and daily life ischemia. Methods: The authors conducted a cross-sectional survey of 3063 community-dwelling, generally healthy postmenopausal women enrolled between 1997 and 2000 in the Myocardial Ischemia and Migraine Study in 10 clinical centers of the 40-center Women’s Health Initiative. Participants, ages 50 to 79 years, completed a questionnaire about occurrence of panic attacks in the previous 6 months and underwent 24-hour ambulatory electrocardiogram monitoring (AECG); 2705 women had valid AECG recordings and panic attack questionnaires. ST depression on AECG, heart rate variability (HRV), and chest pain episodes were compared among women with and without a 6-month history of panic attack. Results: There was no difference in overall prevalence of ischemic episodes during AECG between women with and without panic attacks. Women with a recent history of panic were more likely to experience chest pain during AECG after controlling for potential confounders (odds ratio [OR] = 2.01; 95% confidence interval [CI] = 1.40–2.88), including both nonischemic (OR = 1.83; 95% CI = 1.26–2.65) and ischemic chest pain (OR = 4.94; 95% CI = 1.41–17.30). Although mean HRV was lower in those with panic attacks (p = .017), this was not significant after controlling for confounders. Conclusions: Postmenopausal women with a recent history of panic attacks do not appear to have more daily life ischemia as measured by occurrence of ST depression during 24-hour monitoring, but do have more chest pain and possibly lower HRV, suggesting that even sporadic panic attacks may be related to cardiovascular risk. PD = panic disorder; MIMS = Myocardial Ischemia and Migraine Study; WHI = Women’s Health Initiative; ECG = electrocardiogram; AECG = ambulatory ECG; HRV = heart rate variability; MI = myocardial infarction; CAD = coronary artery disease; CES-D = Center for Epidemiological Studies Depression Scale; CABG = coronary artery bypass surgery; CHD = coronary heart disease.
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Smoller et al. (2006) conducted a cross-sectional in Panic attacks and daily life ischemia (n=3,063). Recent history of panic attacks (previous 6 months) vs. No recent history of panic attacks was evaluated on Chest pain episodes during 24-hour ambulatory ECG (OR 2.01, 95% CI 1.40-2.88). Postmenopausal women with a recent history of panic attacks had a higher likelihood of experiencing chest pain during 24-hour AECG monitoring (OR 2.01; 95% CI 1.40-2.88) compared to those without.
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