Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/99842
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Type: Journal article
Title: Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1 131 612 persons and 58 111 cardiac events
Author: Tully, P.
Turnbull, D.
Beltrame, J.
Horowitz, J.
Cosh, S.
Baumeister, H.
Wittert, G.
Citation: Psychological Medicine, 2015; 45(14):2909-2920
Publisher: Cambridge University Press
Issue Date: 2015
ISSN: 0033-2917
1469-8978
Statement of
Responsibility: 
P. J. Tully, D. A. Turnbull, J. Beltrame, J. Horowitz, S. Cosh, H. Baumeister and G. A. Wittert
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: Aetiology; anxiety disorder; anxiety neurosis; coronary heart disease; meta-analysis; myocardial infarction; panic attack; panic disorder; systematic review
Rights: Copyright © Cambridge University Press 2015
RMID: 0030030051
DOI: 10.1017/S0033291715000963
Grant ID: http://purl.org/au-research/grants/nhmrc/1053578
Appears in Collections:Medicine publications

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