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Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1 131 612 persons and 58 111 cardiac events

Published online by Cambridge University Press:  01 June 2015

P. J. Tully ,
D. A. Turnbull ,
J. Beltrame ,
J. Horowitz ,
S. Cosh ,
H. Baumeister  and
G. A. Wittert
P. J. Tully*
Affiliation:
Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany
D. A. Turnbull
Affiliation:
Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia
J. Beltrame
Affiliation:
School of Medicine, Discipline of Medicine, The University of Adelaide, Australia
J. Horowitz
Affiliation:
School of Medicine, Discipline of Medicine, The University of Adelaide, Australia
S. Cosh
Affiliation:
Clinic of Psychiatry and Psychotherapy II, University of Ulm, Gunzburg, Germany
H. Baumeister
Affiliation:
Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany
G. A. Wittert
Affiliation:
Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia
*
*Address for correspondence: Dr P. J. Tully, Discipline of Medicine, The University of Adelaide, South Australia, 5005Australia. (Email: phillip.tully@adelaide.edu.au)
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Abstract

Background.

Substantial healthcare resources are devoted to panic disorder (PD) and coronary heart disease (CHD); however, the association between these conditions remains controversial. Our objective was to conduct a systematic review of studies assessing the association between PD, related syndromes, and incident CHD.

Method.

Relevant studies were retrieved from Medline, EMBASE, SCOPUS and PsycINFO without restrictions from inception to January 2015 supplemented with hand-searching. We included studies that reported hazard ratios (HR) or sufficient data to calculate the risk ratio and 95% confidence interval (CI) which were pooled using a random-effects model. Studies utilizing self-reported CHD were ineligible. Twelve studies were included comprising 1 131 612 persons and 58 111 incident CHD cases.

Results.

PD was associated with the primary incident CHD endpoint [adjusted HR (aHR) 1.47, 95% CI 1.24–1.74, p < 0.00001] even after excluding angina (aHR 1.49, 95% CI 1.22–1.81, p < 0.00001). High to moderate quality evidence suggested an association with incident major adverse cardiac events (MACE; aHR 1.40, 95% CI 1.16–1.69, p = 0.0004) and myocardial infarction (aHR 1.36, 95% CI 1.12–1.66, p = 0.002). The risk for CHD was significant after excluding depression (aHR 1.64, 95% CI 1.45–1.85) and after depression adjustment (aHR 1.38, 95% CI 1.03–1.87). Age, sex, length of follow-up, socioeconomic status and diabetes were sources of heterogeneity in the primary endpoint.

Conclusions.

Meta-analysis showed that PD was independently associated with incident CHD, myocardial infarction and MACE; however, reverse causality cannot be ruled out and there was evidence of heterogeneity.

Keywords

Aetiologyanxiety disorderanxiety neurosiscoronary heart diseasemeta-analysismyocardial infarctionpanic attackpanic disordersystematic review
Type
Review Article
Information
Psychological Medicine , Volume 45 , Issue 14 , October 2015 , pp. 2909 - 2920
Copyright
Copyright © Cambridge University Press 2015 

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