PTSD Linked to Increased Risk of Death, Cardiovascular Disease

Deborah Brauser

November 24, 2010

November 24, 2010 — Posttraumatic stress disorder (PTSD) is associated with a significantly increased risk for death from any cause and of developing cardiovascular disease, suggests new research.

Results of a new study that evaluated more than 286,000 veterans showed that those with PTSD had twice the risk for death than did those without the disorder.

In a substudy of 637 of the veterans, those with PTSD also had a significantly higher prevalence of atherosclerosis, as measured by increased coronary artery calcium (CAC), than did those without PTSD (76.1% vs 59%).

The findings were presented November 17 at the American Heart Association (AHA) Scientific Sessions 2010 meeting in Chicago, Illinois.

"For the first time...we believe we have found a mechanism by which PTSD could increase the risk of cardiovascular events via atherosclerosis," said coprincipal investigator Naser Ahmadi, MD, research scientist at the Greater Los Angeles Veterans Administration (VA) Medical Center in California, in a news release from the meeting.

"If we focus on early detection and management of cardiovascular risk factors in veterans with PTSD, we might be able to delay the onset of cardiovascular disease," he added.

Higher Mortality

For the study, investigators evaluated electronic medical records of 286,194 veterans (mean age, 63 years; 85.1% male) who underwent psychological examinations during treatment at VA medical centers in California and Nevada. Of these, 637 also underwent CAC scanning.

Results showed that 10.6% of the veterans had PTSD and the overall death rate was 13.2% during a mean follow-up of 116 months. The prevalence of PTSD in the veterans who died was 28.9% vs 8.1% who did not die.

In addition, the all-cause mortality hazard ratio for those with PTSD was 2.41 (95% confidence interval [CI], 2.11 – 2.73; P = .0001) compared with those without the disorder.

The veterans with PTSD also had a lower event-free survival at 79% vs 88% in those without PTSD. The prevalence of CAC greater than 0 was significantly higher for PTSD vs non-PTSD patients (P = .001), as was the severity of CAC (P = .0001).

Finally, patients with CAC greater than 0 and PTSD had a relative risk of death of 1.48 (95% CI, 1.1 – 2.9; P = .01) compared with those with CAC but not PTSD.

Timely and Relevant

"This study on [PTSD] and its link to atherosclerosis in veterans is definitely very timely and very relevant," AHA spokesperson, Jennifer Mieres, MD, medical director at the Center for Learning and Innovation and chief diversity and inclusion officer at North Shore-LIJ Health System in Lake Success, New York, said in a release.

She notes that with wars ongoing in both Afghanistan and Iraq, the study "brings the point that [PTSD] is something real and something we're going to have to deal with for decades to come."

"If a physician or nurse practitioner or psychiatrist is dealing with a veteran with the diagnosis of PTSD, this study forces us to consider [including] cardiovascular disease in the risk assessment.

"Even though the veteran may not have symptoms of chest pain or other risk markers, screening for calcium in this cohort can bring to light subclinical or silent cardiovascular disease. And so treatment strategies can be implemented at an early stage," said Dr. Mieres, who was not involved with this trial.

In addition, she pointed out that "literature is definitely unfolding to show a strong association between stress and cardiovascular disease, heart disease, and heart attacks as well as depression and heart disease. And with PTSD, we have stress and depression as factors...which can lead to not only risk markers of their own but also to unhealthy lifestyle habits."

However, Dr. Mieres stressed that heart disease can be prevented in most patient populations. "Controlling risk factors with simple lifestyle changes as well as with medication can significantly decrease your chances of ever having a heart attack."

The study authors have disclosed no relevant financial relationships.

American Heart Association (AHA) Scientific Sessions 2010: Abstract 14864. Presented November 17, 2010.


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