Tully, P.Turnbull, D.Beltrame, J.Horowitz, J.Cosh, S.Baumeister, H.Wittert, G.2016-06-222016-06-222015Psychological Medicine, 2015; 45(14):2909-29200033-29171469-8978http://hdl.handle.net/2440/99842Background: 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.enCopyright © Cambridge University Press 2015Aetiologyanxiety disorderanxiety neurosiscoronary heart diseasemeta-analysismyocardial infarctionpanic attackpanic disordersystematic reviewJournal article003003005110.1017/S00332917150009630003629771000012-s2.0-849480853062-s2.0-84930371410188026Tully, P. [0000-0003-2807-1313]Turnbull, D. [0000-0002-7116-7073]Beltrame, J. [0000-0002-4294-6510]Horowitz, J. [0000-0001-6883-0703]Cosh, S. [0000-0002-8003-3704]Wittert, G. [0000-0001-6818-6065]