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Abstract
Unrecognized anxiety is a difficult clinical presentation in cardiology. Anxiety leads to recurring emergency department visits and the need for numerous diagnostic evaluations to rule out cardiovascular disease (CVD). This review focuses broadly on anxiety and its subtypes in relation to the onset and progression of CVD while describing helpful guidelines to better identify and treat anxiety. Potential mechanisms of cardiopathogenesis are also described. An emerging literature demonstrates that anxiety disorders increase the risk for incident CVD but a causal relationship has not been demonstrated. Anxiety portends adverse prognosis in persons with established CVD that is independent from depression. The level of clinical priority received by depression should be extended to research and clinical intervention efforts in anxiety. Anxiety holds direct relevance for uncovering mechanisms of cardiopathogenesis, developing novel therapeutic strategies, and initiating clinical interventions in the population at risk of developing heart disease, or those already diagnosed with CVD.
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Affiliation(s)
- Phillip J Tully
- Bordeaux Population Health, University of Bordeaux, U1219, Bordeaux, France. .,Freemasons Foundation Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, Australia. .,INSERM U1219, Université de Bordeaux, 146 rue Léo Saignat - Case 11, 33076, Bordeaux Cedex, France.
| | - Nathan J Harrison
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, Australia.,Department of Cardiology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Peter Cheung
- Department of Cardiology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Suzanne Cosh
- Bordeaux Population Health, University of Bordeaux, U1219, Bordeaux, France
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Machado S, Sancassiani F, Paes F, Rocha N, Murillo-Rodriguez E, Nardi AE. Panic disorder and cardiovascular diseases: an overview. Int Rev Psychiatry 2017; 29:436-444. [PMID: 28893114 DOI: 10.1080/09540261.2017.1357540] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The association between panic disorder (PD) and cardiovascular diseases (CVD) has been extensively studied in recent years and, although some studies have shown anxiety disorders co-existing or increasing the risk of heart disease, no causal hypothesis has been well established. Thus, a critical review was performed of the studies that evaluated the association between PD and cardiovascular diseases; synthesizing the evidence on the mechanisms mediators that theoretically would be the responsible for the causal pathway between PD and CVD, specifically. This overview shows epidemiological studies, and discusses biological mechanisms that could link PD to CVD, such as pleiotropy, heart rate variability, unhealthy lifestyle, atherosclerosis, mental stress, and myocardial perfusion defects. This study tried to provide a comprehensive narrative synthesis of previously published information regarding PD and CVD and open new possibilities of clinical management and pathophysiological understanding. Some epidemiological studies have indicated that PD could be a risk factor for CVD, raising morbidity and mortality in PD, suggesting an association between them. These studies argue that PD pathophysiology could cause or potentiate CVD. However, there is no evidence in favour of a causal relationship between PD and CVD. Therefore, PD patients with suspicions of cardiovascular symptoms need redoubled attention.
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Affiliation(s)
- Sergio Machado
- a Physical Activity Neuroscience Laboratory , Salgado de Oliveira University (UNIVERSO) , Niterói , RJ , Brazil.,b Laboratory of Panic & Respiration (LABPR) , Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,c Intercontinental Neuroscience Research Group
| | - Federica Sancassiani
- d Department of Public Health and Clinical and Molecular Medicine , University of Cagliari , Italy
| | - Flavia Paes
- b Laboratory of Panic & Respiration (LABPR) , Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Nuno Rocha
- c Intercontinental Neuroscience Research Group.,e School of Allied Health Sciences , Polytechnic Institute of Porto , Porto , Portugal
| | - Eric Murillo-Rodriguez
- c Intercontinental Neuroscience Research Group.,f Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud , Universidad Anáhuac Mayab , Mérida , Yucatán , México.,g Grupo de Investigación en Envejecimiento, División Ciencias de la Salud , Universidad Anáhuac Mayab , Mérida , Yucatán , México
| | - Antonio Egidio Nardi
- a Physical Activity Neuroscience Laboratory , Salgado de Oliveira University (UNIVERSO) , Niterói , RJ , Brazil
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Tully PJ, Turnbull DA, Beltrame J, Horowitz J, Cosh S, Baumeister H, Wittert GA. Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1131612 persons and 58111 cardiac events. Psychol Med 2015; 45:2909-2920. [PMID: 26027689 DOI: 10.1017/s0033291715000963] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- P J Tully
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - D A Turnbull
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - J Beltrame
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - J Horowitz
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - S Cosh
- Clinic of Psychiatry and Psychotherapy II,University of Ulm,Gunzburg,Germany
| | - H Baumeister
- Department of Rehabilitation Psychology and Psychotherapy,Institute of Psychology,University of Freiburg,Germany
| | - G A Wittert
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
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The brain acid–base homeostasis and serotonin: A perspective on the use of carbon dioxide as human and rodent experimental model of panic. Prog Neurobiol 2015; 129:58-78. [DOI: 10.1016/j.pneurobio.2015.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 12/14/2022]
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Tully PJ, Wittert GA, Turnbull DA, Beltrame JF, Horowitz JD, Cosh S, Baumeister H. Panic disorder and incident coronary heart disease: a systematic review and meta-analysis protocol. Syst Rev 2015; 4:33. [PMID: 25875199 PMCID: PMC4376084 DOI: 10.1186/s13643-015-0026-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 03/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical presentation of panic disorder and panic attack overlaps many symptoms typically experienced in coronary heart disease (CHD). Etiological links between panic disorder and CHD are controversial and remain largely tenuous. This systematic review aims to pool together data regarding panic disorder with respect to incident CHD or myocardial infarction. METHODS/DESIGN Electronic databases (MEDLINE, EMBASE, PsycINFO and SCOPUS) will be searched using a search strategy exploding the topics for CHD and panic disorder. Authors and reference lists of included studies will also be contacted to identify additional published and unpublished studies. Eligibility criteria are as follows: POPULATION persons without CHD who meet criteria for panic disorder, panic attack, anxiety neurosis or elevated panic disorder symptoms; Comparison: persons without CHD who do not meet criteria for panic disorder, panic attack, anxiety neurosis or elevated panic disorder symptoms; OUTCOME verified fatal and non-fatal CHD at follow-up; including coronary revascularization procedure, coronary artery disease, and myocardial infarction. Studies adopting self-report CHD will be ineligible. Screening will be undertaken by two independent reviewers with disagreements resolved through discussion. Data extraction will include original data specified as hazard ratios, risk ratios, and original cell data if available. Risk of bias assessment will be undertaken by two independent reviewers. Meta-analytic methods will be used to synthesize the data collected relating to the CHD outcomes with Cochrane Review Manager 5.3. DISCUSSION This systematic review aims to clarify whether panic disorder is associated with elevated risk for subsequent CHD. An evaluation of the etiological links between panic disorder with incident CHD might inform evidence-based clinical practice and policy concerning triaging chest pain patients, diagnostic assessment, and psychiatric intervention with panic disorder patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014891 .
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Affiliation(s)
- Phillip J Tully
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany. .,Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, 254 North Terrace, Adelaide, Australia.
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, 254 North Terrace, Adelaide, Australia.
| | - Deborah A Turnbull
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, 254 North Terrace, Adelaide, Australia.
| | - John F Beltrame
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Road, Adelaide, Australia.
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Road, Adelaide, Australia.
| | - Suzanne Cosh
- Clinic of Psychiatry and Psychotherapy II, University of Ulm, Helmholtzstr, Gunzburg, Germany.
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany.
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