title: Does panic disorder increase the risk of coronary heart disease? A cohort study of a national managed care database.
abstract: OBJECTIVE
  The association between panic disorder (PD) and coronary heart disease (CHD) was examined in a large national managed care database.
  
  
  METHODS
  The Integrated Health Care Information Services managed care database is a fully de-identified, Health Insurance Portability and Accountability Act-compliant database and includes complete medical history for more than 17 million managed care lives; data from more than 30 United States health plans covering 7 census regions and from patient demographics, including morbidity, age, and gender. A cohort study was designed with a total of 39,920 PD patients and an equal number of patients without PD. The Cox proportional hazards regression models were used to assess the risk of CHD adjusted for age at entry into the cohort, tobacco use, obesity, depression, and use of medications including angiotensin converting enzyme inhibitors, beta blockers, and statins.
  
  
  RESULTS
  Patients with PD were observed to have nearly a 2-fold increased risk for CHD (HR = 1.87, 95% CI = 1.80-1.91) after adjusting for these factors. There was some evidence of a possible trend toward increased risk in a subgroup of patients diagnosed with depression. After controlling for the aforementioned covariates and comparing these patients with those who did not have a diagnosis of depression, it was noted that patients with a comorbid diagnosis of depression were almost 3 times more likely to develop CHD (HR = 2.60, 95% CI = 2.30-3.01).
  
  
  CONCLUSIONS
  The risk of CHD associated with a diagnosis of PD suggests the need for cardiologists and internists to monitor panic disorder to ensure a reduction in the risk of CHD.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Gomez-Caminero
authors.forename: William A
authors.initials: WA
authors.lastname: Blumentals
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Russo
authors.forename: Regina R
authors.initials: RR
authors.lastname: Brown
authors.forename: Ruby
authors.initials: R
authors.lastname: Castilla-Puentes
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology