Towards the end of 2008, some research was published in the European Heart Journal, which as part of a larger study looked at the links between panic disorder and heart disease. The results of this study were reported fairly widely and one particular article, in the DailyMail, entitled “Panic attack sufferers’ increased heart risk” led the No Panic telephone lines being deluged with calls from panic attack sufferers and, in particular, many calls from people who had previously been reassured that panic attacks do not lead to heart attacks.
The first thing to say is that the stark headline does not accurately represent the very complex findings of the study – for example, while there appeared to be some relationship between an increased level of heart disease in people with a history of panic attacks, on the other hand, the study also showed that people with panic attacks had lower death rates from heart attacks. One of the other difficulties with such research is an issue of “correlation.” Simply put, correlation means that one factor is statistically linked to another factor and, in the case of this study, it appears that, statistically, the more likely you are to have panic attacks, the more likely you are to develop heart disease. However, correlation does not mean cause. Causation of heart disease might well be due to other factors. Thus, for example, it might be that people with panic attacks are less likely to take the requisite amount of physical exercise, might be more liable to smoke or might eat an unhealthy diet. Thus, research such as this is often difficult to interpret. However, regarding the topics of smoking, diet and exercise, the research evidence is much more clear and each of these three factors are very much associated with levels of heart disease. We also know that other factors, such as a genetic predisposition, are also associated with heart disease and such a disposition is very unlikely to be associated in any significant way with panic attacks.
Perhaps we should return to some basics.
First, panic attack sufferers should be well-advised to pay attention to various issues such as diet, exercise and smoking. Indeed, patients presenting to me with panic and other related anxiety disorders, who are overweight, do not do an exercise, smoke and eat unhealthy foods, are likely to get somewhat of an ear bashing from me regarding these topics. I usually say in a very straightforward manner that, as well as attempting various psychological strategies known to improve the condition of people with anxiety disorders, it is essential that clinicians such myself pay attention to improving physical health. It is absolutely clear that people who lose some weight and begin a reasonable and sustained pattern of exercise do much better than patients who remain overweight and sedentary. I also believe that many people with panic disorders, because of their condition simply let their attention to health matters slip, possibly because they have given up or because of poor self esteem. Paying attention to improving your physical health and making yourself a priority seem to me to be of central importance.
Finally, it is important that we all avail ourselves of a proportionate amount of health screening, ensuring that those of us – particularly over a certain age – have regular checks of blood pressure and that although symptoms such as shortness of breath and chest pain may be part of panic attacks, those suffering such symptoms should go to their GP and have the basis of these symptoms properly checked out.
The article also raises the old topic of whether one can die in the midst of a panic attack. My answer to this question is quite simple – and that is for 33 years I have seen a very large number of patient with panic attacks. Each and every one of them have suffered a large number of episodes. I cannot remember any patient dying during a panic attack.
One also needs to remember that panic are characterised by an outpouring of adrenaline and this the very substance that is used in resuscitation attempts because of its beneficial action on the heart. Anxiety is a state of fight or flight and in such a condition, the body is in an optimum state of preparedness. Thus, our vital organs, including our hearts, are flooded with oxygenated blood; this I think being the reasons why deaths are very unlikely to occur during panic attacks.
Professor Kevin Gournay is an Emeritus Professor at the Institute of Psychiatry. He has more than 35 years of experience and is the author of more than 130 articles and books. He is based in Cheshunt Hertfordshire.