Posttraumatic Stress Disorder and Risk for CHD
Objective The aim of this study was to estimate the association of posttraumatic stress disorder (PTSD) with risk for incident coronary heart disease (CHD).
Design A systematic review and meta-analysis were used as study designs.
Data Sources Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and PubMed Related Articles and through a manual search of reference lists (1948-present).
Study Selection All studies that assessed PTSD in participants initially free of CHD and subsequently assessed CHD/cardiac-specific mortality were included.
Data Extraction Two investigators independently extracted estimates of the association of PTSD with CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HRs), and a random-effects model was used to pool results. A secondary analysis including only studies that reported estimates adjusted for depression was conducted.
Results Six studies met our inclusion criteria (N = 402,274); 5 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.55 (95% CI 1.34–1.79) before adjustment for depression. The pooled HR estimate for the 5 depression-adjusted estimates (N = 362,950) was 1.27 (95% CI 1.08–1.49).
Conclusion Posttraumatic stress disorder is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. It is common in both military veterans and civilian trauma survivors, and these results suggest that it may be a modifiable risk factor for CHD. Future research should identify the mechanisms of this association and determine whether PTSD treatment offsets CHD risk.
Posttraumatic stress disorder (PTSD) is a common, disabling mental health disorder that occurs in individuals who are exposed to traumatic events such as combat, intimate partner violence, or natural disasters. The estimated lifetime prevalence of PTSD in developed nations is 4.4%, and ranges from 12.1% to 30.9% in military veterans. Individuals with PTSD experience a number of disabling symptoms such as intrusive thoughts, nightmares, flashbacks, avoidance of reminders of the traumatic event, and physiological arousal and are at increased risk for suicide, substance abuse, and inability to work.
Although the profound impact of PTSD on mental health has long been recognized, there has more recently been increasing awareness that individuals with PTSD are at increased risk for physical health impairments, most notably with respect to cardiovascular health. Aside from its association with cardiovascular risk behaviors such as smoking, alcohol abuse, and nonadherence to medications, PTSD has been cross sectionally associated with hypertension, dyslipidemia, obesity, and diabetes in young veterans of Operations Iraqi Freedom and Enduring Freedom and with blood-based measures of endothelial dysfunction and low-grade systemic inflammation in young civilians.
Although recent studies are elucidating associations between PTSD and coronary heart disease (CHD) risk factors, it is less clear whether PTSD is independently associated with incident CHD and cardiac-specific mortality risk. Accordingly, we used systematic review and meta-analysis to examine the prospective association of PTSD with incident CHD and cardiac-specific mortality. Because PTSD is often comorbid with depression, a factor shown to increase risk for CHD and mortality, we additionally adjusted for depression in determining estimates of the association of PTSD with CHD.
Abstract and Introduction
Abstract
Objective The aim of this study was to estimate the association of posttraumatic stress disorder (PTSD) with risk for incident coronary heart disease (CHD).
Design A systematic review and meta-analysis were used as study designs.
Data Sources Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and PubMed Related Articles and through a manual search of reference lists (1948-present).
Study Selection All studies that assessed PTSD in participants initially free of CHD and subsequently assessed CHD/cardiac-specific mortality were included.
Data Extraction Two investigators independently extracted estimates of the association of PTSD with CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HRs), and a random-effects model was used to pool results. A secondary analysis including only studies that reported estimates adjusted for depression was conducted.
Results Six studies met our inclusion criteria (N = 402,274); 5 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.55 (95% CI 1.34–1.79) before adjustment for depression. The pooled HR estimate for the 5 depression-adjusted estimates (N = 362,950) was 1.27 (95% CI 1.08–1.49).
Conclusion Posttraumatic stress disorder is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. It is common in both military veterans and civilian trauma survivors, and these results suggest that it may be a modifiable risk factor for CHD. Future research should identify the mechanisms of this association and determine whether PTSD treatment offsets CHD risk.
Introduction
Posttraumatic stress disorder (PTSD) is a common, disabling mental health disorder that occurs in individuals who are exposed to traumatic events such as combat, intimate partner violence, or natural disasters. The estimated lifetime prevalence of PTSD in developed nations is 4.4%, and ranges from 12.1% to 30.9% in military veterans. Individuals with PTSD experience a number of disabling symptoms such as intrusive thoughts, nightmares, flashbacks, avoidance of reminders of the traumatic event, and physiological arousal and are at increased risk for suicide, substance abuse, and inability to work.
Although the profound impact of PTSD on mental health has long been recognized, there has more recently been increasing awareness that individuals with PTSD are at increased risk for physical health impairments, most notably with respect to cardiovascular health. Aside from its association with cardiovascular risk behaviors such as smoking, alcohol abuse, and nonadherence to medications, PTSD has been cross sectionally associated with hypertension, dyslipidemia, obesity, and diabetes in young veterans of Operations Iraqi Freedom and Enduring Freedom and with blood-based measures of endothelial dysfunction and low-grade systemic inflammation in young civilians.
Although recent studies are elucidating associations between PTSD and coronary heart disease (CHD) risk factors, it is less clear whether PTSD is independently associated with incident CHD and cardiac-specific mortality risk. Accordingly, we used systematic review and meta-analysis to examine the prospective association of PTSD with incident CHD and cardiac-specific mortality. Because PTSD is often comorbid with depression, a factor shown to increase risk for CHD and mortality, we additionally adjusted for depression in determining estimates of the association of PTSD with CHD.