title: Is there cardiac risk in panic disorder? An updated systematic review.
abstract: BACKGROUND
  The recognized relationship between panic disorder (PD) and cardiac disorders (CDs) is not unequivocal. We reviewed the association between PD and coronary artery disease (CAD), arrhythmias, cardiomyopathies, and sudden cardiac death.
  
  
  METHODS
  We undertook an updated systematic review, according to PRISMA guidelines. Relevant studies dating from January 1, 2000, to December 31, 2014, were identified using the PubMed database and a review of bibliographies. The psychiatric and cardiac diagnostic methodology used in each study was then to very selective inclusion criteria.
  
  
  RESULTS
  Of 3044 studies, 14 on CAD, 2 on cardiomyopathies, and 1 on arrhythmias were included. Overall, the studies supported a panic-CAD association. Furthermore, in some of the studies finding no association between current full-blown PD and CAD, a broader susceptibility to panic, manifesting as past PD, current agoraphobia, or subthreshold panic symptoms, appeared to be relevant to the development of CAD. Preliminary data indicated associations between panic, arrhythmias, and cardiomyopathies.
  
  
  CONCLUSIONS
  The studies were largely cross-sectional and conducted in cardiological settings. Only a few included blind settings. The clinical conditions of patients with CDs and the qualifications of raters of psychiatric diagnoses were highly heterogeneous. CDs other than CAD had been insufficiently investigated.
  
  
  CONCLUSIONS
  Our review supported a relationship between PD and CDs. Given the available findings and the involvement of the cardiorespiratory system in the pathophysiology of PD, an in-depth investigation into the panic-CDs association is highly recommended. This should contribute to improved treatment and prevention of cardiac events and/or mortality, linked to PD.
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, 22032 Albese con Cassano, Como, Italy. Electronic address: caldiroladaniela@gmail.com.
authors.forename: Daniela
authors.initials: D
authors.lastname: Caldirola
authors.affiliation: Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, The Netherlands; Center for the Psychology of Learning and Experimental Psychopathology, Department of Psychology, University of Leuven, Tiensestraat 102, P.O. Box 3726, 3000 Leuven, Belgium.
authors.forename: Koen R
authors.initials: KR
authors.lastname: Schruers
authors.affiliation: Laboratory of Panic and Respiration, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Nardi
authors.affiliation: National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: De Berardis
authors.affiliation: Department of Education Science, University of Catania, Catania, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Fornaro
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, 22032 Albese con Cassano, Como, Italy; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, The Netherlands; Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, 33136 Miami, USA.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Perna
mesh_terms: D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D009202:Cardiomyopathies / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D016584:Panic Disorder / Q000453:epidemiology*; D012306:Risk
keywords: Cardiac disease; Cardiac risk; Panic