title: Panic attacks, daily life ischemia, and chest pain in postmenopausal women.
abstract: BACKGROUND
  Chest pain is a common symptom of panic attacks, but little is known about the relationship in older women among panic attacks, chest pain, and daily life ischemia.
  
  
  METHODS
  The authors conducted a cross-sectional survey of 3063 community-dwelling, generally healthy postmenopausal women enrolled between 1997 and 2000 in the Myocardial Ischemia and Migraine Study in 10 clinical centers of the 40-center Women's Health Initiative. Participants, ages 50 to 79 years, completed a questionnaire about occurrence of panic attacks in the previous 6 months and underwent 24-hour ambulatory electrocardiogram monitoring (AECG); 2705 women had valid AECG recordings and panic attack questionnaires. ST depression on AECG, heart rate variability (HRV), and chest pain episodes were compared among women with and without a 6-month history of panic attack.
  
  
  RESULTS
  There was no difference in overall prevalence of ischemic episodes during AECG between women with and without panic attacks. Women with a recent history of panic were more likely to experience chest pain during AECG after controlling for potential confounders (odds ratio [OR] = 2.01; 95% confidence interval [CI] = 1.40-2.88), including both nonischemic (OR = 1.83; 95% CI = 1.26-2.65) and ischemic chest pain (OR = 4.94; 95% CI = 1.41-17.30). Although mean HRV was lower in those with panic attacks (p = .017), this was not significant after controlling for confounders.
  
  
  CONCLUSIONS
  Postmenopausal women with a recent history of panic attacks do not appear to have more daily life ischemia as measured by occurrence of ST depression during 24-hour monitoring, but do have more chest pain and possibly lower HRV, suggesting that even sporadic panic attacks may be related to cardiovascular risk.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA. jsmoller@hms.harvard.edu
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Smoller
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
authors.forename: Sylvia
authors.initials: S
authors.lastname: Wassertheil-Smoller
authors.forename: Robert
authors.initials: R
authors.lastname: Brunner
authors.forename: David
authors.initials: D
authors.lastname: Curb
authors.forename: James
authors.initials: J
authors.lastname: Torner
authors.forename: Albert
authors.initials: A
authors.lastname: Oberman
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hendrix
authors.forename: Judith
authors.initials: J
authors.lastname: Hsia
authors.forename: David S
authors.initials: DS
authors.lastname: Sheps
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002637:Chest Pain / Q000209:etiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006306:Health Surveys; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000523:psychology*; D016584:Panic Disorder; D017698:Postmenopause; D012307:Risk Factors