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Using medical records from a U.S. health insurance database, researchers found that adults who had been diagnosed with panic disorder were nearly twice as likely as those without the disorder to develop coronary heart disease. The risk was higher still among patients diagnosed with both panic disorder and depression -- two psychiatric conditions that are often seen together.

Estimated to affect more than 2 million Americans in any given year, panic disorder involves "attacks" of intense fear that come out of nowhere. The physical symptoms, including chest pain, breathlessness and dizziness, can mimic a heart attack. And some evidence has suggested that panic attacks may actually predispose a person to developing heart disease.

In the new study, reported in the journal Psychosomatic Medicine, researchers examined data from a managed care database on nearly 40,000 people diagnosed with panic disorder and a similar number without the condition.

Overall, those with panic disorder were 87 percent more likely to suffer a heart attack or develop chest pains caused by impaired blood flow to the heart.

People with a history of depression were also at heightened risk of heart disease -- something that has been seen in previous studies -- and the combination of panic disorder and depression was linked to a 3-fold increase in heart disease risk, according to the researchers, led by Dr. Andres Gomez-Caminero.

The findings, they conclude, suggest that "early detection of panic disorder may prevent the occurrence of coronary heart disease."

Gomez-Caminero, who was based at the University of Pennsylvania in Philadelphia at the time of the study, is now with drug maker Bristol-Myers Squibb.

The study was funded by GlaxoSmithKline Pharmaceuticals, which makes Paxil, an antidepressant that is also prescribed for panic disorder.

It's not fully clear why panic disorder may increase heart disease risk, but chronic effects on the nervous system may be involved, according to the researchers. A number of studies have linked chronic stress to heart disease risk, and depression, scientists speculate, may harm the heart through effects on the nervous system, stress hormones or blood-clotting substances.

The fact that panic disorder and depression had an additive effect in this study, Gomez-Caminero and his colleagues note, suggests that the two conditions have different effects on the cardiovascular system.

The findings, they write, "reaffirm" the need for early treatment of panic disorder and other forms of chronic anxiety -- though studies have not shown whether treatment lowers patients' risk of developing heart disease.

Besides antidepressants, panic disorder can be treated through cognitive behavioral therapy, which aims to change the thoughts and behaviors that set the stage for panic attacks."MedlinePlus: Panic Disorder Seems to Raise Heart Disease Risk