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Panic Attacks, Daily Life Ischemia, and Chest Pain in Postmenopausal Women

From the Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts (J.W.S., M.H.P.); Albert Einstein College of Medicine, Bronx, New York (S.W.-S.); the University of Nevada School of Medicine, Reno, Nevada (R.B.); the University of Hawaii, Honolulu, Hawaii (D.C.); the University of Iowa, Iowa City, Iowa (J.T.); Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (A.O.); Department of Obstetrics and Gynecology, Wayne State University, Hutzel Women’s Hospital, Detroit, Michigan (S.L.H.); George Washington University Medical Center, Washington, DC (J.H.); and the University of Florida, Gainesville, Florida, and Malcom Randall VA Medical Center Gainesville, Florida (D.S.S.).

Address correspondence and reprint requests to Jordan W. Smoller, MD, ScD, Massachusetts General Hospital, Simches Research Building, 185 Cambridge Street, Suite 2200, Boston, MA 02114. E-mail: jsmoller{at}hms.harvard.edu

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.

Key Words: daily life ischemia • postmenopausal women • panic • chest pain • panic disorder

Abbreviations: 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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				J. W. Smoller, M. H. Pollack, S. Wassertheil-Smoller, R. D. Jackson, A. Oberman, N. D. Wong, and D. Sheps Panic Attacks and Risk of Incident Cardiovascular Events Among Postmenopausal Women in the Women's Health Initiative Observational Study Arch Gen Psychiatry, October 1, 2007; 64(10): 1153 - 1160. [Abstract] [Full Text] [PDF]