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Increased Risk of Acute Myocardial Infarction for Patients With Panic Disorder: A Nationwide Population-Based Study

From the School of Public Health (Y.-H.C.), Taipei Medical University, Taipei, Taiwan; School of Medicine (S.-Y.T., H.-C.L.), Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; AND School of Health Care Administration (H.-C.L.), Taipei Medical University, Taipei, Taiwan.

Address correspondence and reprint requests to Herng-Ching Lin, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan. E-mail: henry11111{at}tmu.edu.tw

Objective: To examine prospectively the relationship between a diagnosis of panic disorder and the risk of acute myocardial infarction within 1 year of follow-up. Panic disorder is associated prospectively with coronary artery disease, but the risk of acute myocardial infarction associated with panic disorder has not been specifically investigated.

Method: This nationwide population-based study used data from the Taiwan National Health Insurance Research Database covering the years 2000 to 2005. A total of 9641 patients diagnosed with panic disorder in 2004 were included, together with 28,923 matched nonpanic disorder enrollees as a comparison cohort. Cox proportional hazard regressions were conducted to compute hazard ratios, after adjustment for comorbid medical disorders and sociodemographic characteristics.

Results: Results indicated that 4.77% of patients with panic disorder (approximately one in 21) experienced an acute myocardial infarction episode within a year, compared with 2.73% of patients in the comparison cohort. The adjusted hazard of acute myocardial infarction was significantly higher (1.75 times, 95% Confidence Interval = 1.55-1.97) for patients with panic disorder, relative to the comparison cohort. The association persisted in further analyses stratified by hypertension, coronary heart diseases, and age.

Conclusion: Panic disorder was identified as an independent risk factor for subsequent acute myocardial infarction. Comprehensive multidisciplinary approaches are needed to optimize primary and secondary prevention of acute myocardial infarction among patients with panic disorder.

Key Words: panic disorder • acute myocardial infarction • coronary artery disease • psychosomatic disorder

Abbreviations: PD = panic disorder; CHD = coronary heart disease; AMI = acute myocardial infarction; MI = myocardial infarction; NHIRD = National Health Insurance Research Database; NHI = National Health Insurance program; HR = hazard ratio; CI = Confidence Interval; HRV = heart rate variability.