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Does Panic Disorder Increase the Risk of Coronary Heart Disease? A Cohort Study of a National Managed Care Database

From the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (A.G.-C., L.J.R., R.C.-P.); Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida (W.A.B.); Worldwide Epidemiology, GlaxoSmithKline Pharmaceuticals, Collegeville, Pennsylvania (R.R.B.); Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina (R.C.-P.)

Address correspondence and reprint requests to Ruby Castilla-Puentes, BX4-406E, 200 Crossing Boulevard, PO Box 6890, Bridgewater, NJ 08807-0890. E-mail: castilla{at}email.unc.edu

Objective: The association between panic disorder (PD) and coronary heart disease (CHD) was examined in a large national managed care database.

Methods: The Integrated Health Care Information Services managed care database is a fully de-identified, Health Insurance Portability and Accountability Act-compliant database and includes complete medical history for more than 17 million managed care lives; data from more than 30 United States health plans covering 7 census regions and from patient demographics, including morbidity, age, and gender. A cohort study was designed with a total of 39,920 PD patients and an equal number of patients without PD. The Cox proportional hazards regression models were used to assess the risk of CHD adjusted for age at entry into the cohort, tobacco use, obesity, depression, and use of medications including angiotensin converting enzyme inhibitors, beta blockers, and statins.

Results: Patients with PD were observed to have nearly a 2-fold increased risk for CHD (HR = 1.87, 95% CI = 1.80–1.91) after adjusting for these factors. There was some evidence of a possible trend toward increased risk in a subgroup of patients diagnosed with depression. After controlling for the aforementioned covariates and comparing these patients with those who did not have a diagnosis of depression, it was noted that patients with a comorbid diagnosis of depression were almost 3 times more likely to develop CHD (HR = 2.60, 95% CI = 2.30–3.01).

Conclusions: The risk of CHD associated with a diagnosis of PD suggests the need for cardiologists and internists to monitor panic disorder to ensure a reduction in the risk of CHD.

Key Words: panic disorder • risk • coronary heart disease • Integrated Health Care Information Services • acute myocardial infarction

Abbreviations: CHD = coronary heart disease; HR = hazard ratio; CI confidence interval; IHCIS = Integrated Health Care Information Services; PD = panic disorder; ACE = angiotensin converting enzyme; NPD = nonpanic disorder.

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