title: Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1131612 persons and 58111 cardiac events.
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.
  
  
  METHODS
  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.
authors.affiliation: Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia.
authors.forename: D A
authors.initials: DA
authors.lastname: Turnbull
authors.affiliation: School of Medicine,Discipline of Medicine,The University of Adelaide,Australia.
authors.forename: J
authors.initials: J
authors.lastname: Beltrame
authors.affiliation: School of Medicine,Discipline of Medicine,The University of Adelaide,Australia.
authors.forename: J
authors.initials: J
authors.lastname: Horowitz
authors.affiliation: Clinic of Psychiatry and Psychotherapy II,University of Ulm,Gunzburg,Germany.
authors.forename: S
authors.initials: S
authors.lastname: Cosh
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy,Institute of Psychology,University of Freiburg,Germany.
authors.forename: H
authors.initials: H
authors.lastname: Baumeister
authors.affiliation: Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia.
authors.forename: G A
authors.initials: GA
authors.lastname: Wittert
mesh_terms: D001007:Anxiety; D001008:Anxiety Disorders / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology*; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology*; D016017:Odds Ratio; D016584:Panic Disorder / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors
keywords: Aetiology; anxiety disorder; anxiety neurosis; coronary heart disease; meta-analysis; myocardial infarction; panic attack; panic disorder; systematic review