Panic attacks and risk of incident cardiovascular events among postmenopausal women in the women's health initiative observational study

Context: Previous studies have documented an association of depression and phobic anxiety with cardiovascular morbidity and mortality, but little is known about the cardiovascular sequelae of panic anxiety. Objective: To determine whether panic attacks are associated with risk of cardiovascular morbidity and mortality in postmenopausal women. Design: Prospective cohort survey. Setting: Ten clinical centers of the 40- center Women's Health Initiative. Participants: A total of 3369 community- dwelling, generally healthy postmenopausal women ( aged 51- 83 years) enrolled between 1997 and 2000 in the Myocardial Ischemia and Migraine Study who completed a questionnaire about occurrence of panic attacks in the previous 6 months. Main Outcome Measures: Cardiovascular/ cerebrovascular outcomes ( fatal and nonfatal myocardial infarction and stroke) and all- cause mortality were ascertained after a mean of 5.3 years of follow- up. Results: A 6- month history of full- blown panic attacks, endorsed by 10% of postmenopausal women in this cohort, was associated with both coronary heart disease ( hazard ratio, 4.20; 95% confidence interval, 1.76- 9.99) and the combined end point of coronary heart disease or stroke ( hazard ratio, 3.08; 95% confidence interval, 1.60- 5.94) after controlling for multiple potential confounders. The hazard ratio for all- cause mortality, excluding those with a history of cardiovascular/ cerebrovascular events, was 1.75 ( 95% confidence interval, 1.04- 2.94). Conclusion: Panic attacks are relatively common among postmenopausal women and appear to be an independent risk factor for cardiovascular morbidity and mortality in older women.