Older women who have at least one full-blown panic attack may have an increased risk of having a myocardial infarction or stroke and an increased risk of death in the next five years, according to an article in the October issue of Archives of General Psychiatry.

Jordan W. Smoller, MD, ScD, of Massachusetts General Hospital, Boston, and colleagues studied 3,369 healthy postmenopausal women (age 51 to 83 years, average age 65.9 years). At enrollment between 1997 and 2000, the women completed a questionnaire about the occurrence of panic attacks in the previous six months. They were then followed for an average of 5.3 years to see whether they had a myocardial infarction or stroke or died from any cause.

About 10 percent of women reported having a full-blown panic attack in the six months prior to enrollment. After researchers adjusted for other cardiovascular risk factors, having one or more panic attacks was associated with four times the risk of myocardial infarction, three times the risk for myocardial infarction or stroke and nearly twice the risk of death from any cause. These associations remained after controlling for depression, suggesting that panic attacks may be a separate, independent risk factor for cardiovascular events.

The results add panic attacks to the list of emotions and psychiatric symptoms that have already been linked to cardiovascular risk, including depression, anger and hostility, the authors noted. Panic attacks could be associated with other cardiovascular risk factors, such as hypertension. Alternatively, anxiety could contribute to adverse cardiovascular effects, such as coronary artery spasm, tendency toward increased blood clotting or disturbances in heart rhythm.

“These results suggest that panic anxiety is a marker for increased risk of cardiovascular morbidity and mortality among postmenopausal women,” the authors concluded. “Future studies are needed to clarify the causal connection, if any, between panic attacks and cardiovascular events. Our results imply, however, that older women with a recent history of panic attacks represent a subgroup at elevated risk of myocardial infarction and stroke in whom careful monitoring and cardiovascular risk reduction may be particularly important.”