SAN FRANCISCO — Veterans diagnosed with posttraumatic stress disorder (PTSD) are at higher risk of developing insulin resistance and metabolic syndrome than their counterparts without PTSD, new research shows.

Presenting the findings at the American College of Cardiology 2013 Scientific Sessions earlier this week, interventional cardiologist Ramin Ebrahimi, MD, from the University of California, Los Angeles, told Medscape Medical News: "PTSD is an important predictor for cardiac and metabolic disorders, and these patients may need to be watched a little bit closer." Although Dr. Ebrahimi made his observations in veterans, he stressed that anyone with PTSD is vulnerable. "PTSD is not an isolated disorder that is only seen in veterans, it's seen in all patients across the world everywhere, and it needs to be viewed as a disorder that can be treated."

He added: "We published an article 2 years ago looking at PTSD and coronary artery disease [CAD], and those with PTSD had significantly more CAD and a higher mortality. This was a secondary trial looking back to see whether the incidence of some of these risk factors would be higher, and we have now documented that."

Currently, treatment of PTSD is limited to managing the psychiatric symptoms of the condition, but this work shows that attention needs to be paid to other components of the illness, he said. "It behooves us to watch these patients a little more closely, even if they are young, and be more vigilant in terms of treating their risk factors, because insulin resistance and metabolic syndrome can be reversed during their early stages with lifestyle modifications."

Half of PTSD Patients Had Metabolic Syndrome

Dr. Ramin Ebrahimi

Dr. Ebrahimi and colleagues performed a retrospective study on 207,954 veterans in Southern California and Nevada who were between the ages of 46 and 74 years (average age 60 years, 93% male) with and without PTSD.

All subjects were identified in a primary-care setting and had no known history of heart disease or diabetes. Participants were followed for a median of 2 years to see whether they developed insulin resistance and/or metabolic syndrome; all data were obtained through Veterans Association electronic medical records. At baseline, there were no significant differences in lipid profiles, fasting blood sugars, and conventional risk factors between those with and without PTSD.

At follow-up, insulin resistance was found in significantly more veterans with PTSD, occurring in 34.8% of them compared with 19.3% of those without PTSD ( P = .00001). Similarly, metabolic syndrome was more likely to be present in the PTSD group, with over half of them showing the cluster of symptoms (52.5% compared with 37.3% in those without PTSD; P = .00001)

After adjustment for age, gender, ethnicity, hypertension, hypercholesterolemia, and family history of premature CAD and obesity, PTSD was still independently associated with higher rates of insulin resistance and metabolic syndrome. The adjusted incidence rate of insulin resistance and metabolic syndrome was 14.2% and 12.07% in PTSD as compared with non-PTSD, respectively (P < .05).

And the population risk of insulin resistance and metabolic syndrome attributable to PTSD was 49% and 41% respectively, said Dr. Ebrahimi.

Treat Medical and Psychiatric Components of PTSD

Dr. Ebrahimi said he first noticed the link between cardiometabolic risk and PTSD a few years ago: "I had been putting stents in these patients for a long time, and I came to realize that there was a disproportionate number coming to the cath lab with the diagnosis of PTSD. Whereas the prevalence of PTSD might have been 5%, 15% to 20% of the patients I was seeing had PTSD, and that was the impetus to look at whether something was there.

"I cannot go so far as to say PTSD is a risk factor, because this is a retrospective data analysis," he added, "but we are in the process of considering prospectively following these patients to see what happens.

"What we do know is that [PTSD] is somehow associated with end results that are not good. Whether it's directly or indirectly, we have identified something that translates to cardiovascular risk and metabolic syndrome."

By focusing on the early detection and management of PTSD-related medical conditions, including metabolic disorders and atherosclerosis, in conjunction with the psychiatric components, "long-term adverse events related to PTSD may be significantly reduced or prevented,” he concluded.

American College of Cardiology 2013 Scientific Sessions. Presented March 9, 2013. Abstract 1102-19

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