The rapid pulse and shortness of breath of a panic attack can feel like a heart attack, and it may signal heart trouble down the road, a study of more than 3,000 older women suggests.

Women who reported at least one full-blown panic attack during a six-month period were three times more likely to have a heart attack or stroke over the next five years than women who didn't report a panic attack.

The researchers took into account other risk factors such as smoking, high blood pressure, inactivity and depression and still found that panic attacks raised risk.

The findings add panic attacks to a list of mental health issues — depression, fear, hostility and anxiety — already linked in previous research to heart problems, said study co-author Dr. Jordan Smoller of Boston's Massachusetts General Hospital.

"Postmenopausal women who are experiencing panic attacks may be a subgroup with elevated risk," Smoller said. "Monitoring them and reducing their cardiovascular risk may be important."

The study, published in Monday's Archives of General Psychiatry, wasn't designed to explain the link, Smoller said. He speculated that a panic attack may trigger heart rhythm problems or that stress hormones released during an attack may harm the heart.

The findings don't surprise Susie Rissler, 51, of Terre Haute, Ind. A panic attack sufferer since childhood, she's also has had three mini-strokes.

"You feel like the whole world is caving in," Rissler said of her panic attacks, which can include a racing heartbeat and chest pains. "I've had shaking, sweating, curling up in a ball totally afraid to even look around. Panic attacks can really destroy a person in a lot of different ways."

Some of the reported panic symptoms may have been heart problems in disguise, Smoller said. Symptoms such as racing heart, chest pain or shortness of breath, experienced as a panic attack, may have been caused by an undiagnosed heart problem.

"One study doesn't settle a question," he cautioned. "The number of events seen in this sample is still relatively small." Forty-one of the 3,243 women in the analysis had a heart attack or death from a heart problem. An additional 40 had strokes.

The study, which enrolled women from 1997-2000 and followed them for five years, was funded by the drug company Glaxo Wellcome, which is now GlaxoSmithKline PLC. The company makes Paxil, an anti-anxiety drug. Some of the study's co-authors reported financial ties to that company and others.

The research relied on the women's memories, rather than doctors' diagnoses, which could be considered a weakness of the study, said Dr. JoAnn Manson of Harvard's Brigham and Women's Hospital. But Manson, who wasn't involved in the study, said it's likely the findings point to a real connection between panic and heart problems.

"It does tie together very well with what we know about the biology and physiology of the stress hormones," Manson said. "I think it does suggest that this is something to discuss with your doctor" for women prone to panic attacks.

Previous research has found that panic attacks are more common in women than in men. The researchers found that 330 of the women, ages 51 to 83 years at the start of the study, reported a full-blown panic attack during the previous six months. Of those, about 4 percent, went on to have a heart attack or stroke. That compares with 2 percent of the women who reported no panic attacks but who had heart attacks or strokes.

Once the researchers adjusted for other health factors, they found the heart and stroke risk three times greater among women who had panic attacks.

A full-blown attack was defined as a sudden attack of fear, anxiety or discomfort accompanied by at least four of 12 symptoms, such as shortness of breath.

Laura Kubzansky of the Harvard School of Public Health, who wasn't involved in the new study but does similar research, said stress hormones may cause immediate heart damage or wear-and-tear over time. During panic, "the body is flooded with hormones that in the short run help the body cope with an emergency, but in the long run take a toll," she said.

While treating panic with medication may help some people with the psychological distress, there's no evidence yet that medication alone reduces heart risk, Kubzansky said.

"We still don't know how best to address this or how reversible these effects are," Kubzansky said.