Anxiety, panic disorder and coronary artery disease: issues concerning physical exercise and cognitive behavioral therapy

Abstract

Psychological factors such as stress and depression have already been established as primary and secondary cardiovascular risk factors. More recently, the role of anxiety in increasing cardiac risk has also been studied. The underlying mechanisms of increased cardiac risk in panic disorder patients seem to reflect the direct and indirect effects of autonomic dysfunction, as well as behavioral risk factors associated with an unhealthy lifestyle. Implications of the comorbidity between panic and cardiovascular disease include higher morbidity, functional deficits, increased cardiovascular risk, and poor adherence to cardiac rehabilitation or exercise programs. This article probes the most recent evidence on the association between coronary artery disease, anxiety and panic disorder, and discusses the potential role of incorporating regular physical exercise and cognitive behavioral therapy in the treatment of this condition.

Panic disorder and exercise avoidance

“…The present study results are also fully consistent with those reported by Sardinha et al 47 in a systematic review, where they proposed that the underlying mechanisms of increased cardiac risk in PD patients would reflect the direct and indirect effects of autonomic dysfunction, as well as behavioral risk factors associated with an unhealthy lifestyle, which may be associated with exercise avoidance. 47 There are limitations to generalizing the results of the present study and stating that PD is a risk factor for cardiovascular disease due to sedentary lifestyle.…”

“…47 There are limitations to generalizing the results of the present study and stating that PD is a risk factor for cardiovascular disease due to sedentary lifestyle. The most important is that the possibility that general distress and unspecified stress-related metabolic changes may underlie a common etiological factor shared by these conditions cannot be ruled out.…”

A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind

“…The Panic Attack Treatment in Comorbid Heart Diseases (PATCHD) model was developed explicitly in relation to CHD and HF, which represent leading causes for hospital admissions and global morbidity burden (Murray et al, 2012). The PATCHD model is backed by experience garnered from providing CBT, clinical assessment and recommendations to a diverse range of cardiac patients across public and private hospitals, and cardiac rehabilitation services, in conjunction with cardiologists, cardiac nurses and exercise physiologists (Ramos, Sardinha, Nardi, & Araújo, 2014 ;Sardinha et al, 2012;Sardinha et al, 2011;Sardinha, Nardi, Araujo, Ferreira, & Eifert, 2013;Sardinha, Nardi, & Zin, 2009; P. J. Tully, Selkow, Bengel, & Rafanelli, 2015; P. J.…”

Compromised cerebrovascular modulation in chronic anxiety: evidence from cerebral blood flow velocity measured by transcranial Doppler sonography

“…The implications of comorbidity between anxiety and cardiovascular disease include higher morbidity, functional deficits, increased cardiovascular risk, and poor adherence to cardiac rehabilitation or exercise programs [15] . A study performed in a psychiatric hospital showed that those suffering from anxiety had a mortality rate for cardiovascular causes that was double than expected compared with non-anxious patients of the same age group, gender and time of hospitalization [16] .…”