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PTSD Is a Chaperone, Not a Cause, of Cardiovascular Risk

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Authors: Scherrer JF et al. 

J Am Heart Assoc 2019 Feb 19

The observed links between PTSD and incident cardiovascular disease are likely due to other common psychiatric and medical risk factors.

Post-traumatic stress disorder (PTSD) has been identified as a risk factor for cardiovascular disease (CVD) even in studies controlling for traditional CVD risk factors such as smoking, hypertension, and diabetes. Using time-dependent covariate analyses that controlled for other disorders, researchers examined Veterans Health Affairs (VA) electronic medical records from 2519 patients with PTSD diagnoses and 1659 patients without PTSD aged between 30 and 70 (87% men). PTSD patients were seen at least twice in a PTSD clinic.

Researchers determined PTSD severity via PTSD Checklist (PCL) scores and incident CVD over 3 years via International Classification of Diseases–9 codes for CVD (hypertensive heart disease, myocardial infarction, ischemic heart disease, disease of pulmonary circulation, other heart disease) or revascularization procedures.

Age-adjusted incident CVD rate was significantly higher in PTSD patients than controls (46.7/1000 vs. 33.3/1000 person-years). PTSD patients were more likely to be smokers, younger, black, and obese and to have high healthcare use; depression, anxiety, sleep, and substance use disorders; diabetes; hypertension; and hyperlipidemia. PTSD (but not PCL score) was associated with incident CVD (age-adjusted hazard ratio, 1.41). The association was reduced by 44% after adjustment for diabetes, obesity, hypertension, and hyperlipidemia and was no longer significant after adjustment for smoking and psychiatric disorders.

COMMENT

A combination of CVD risk factors common in PTSD patients seems to account for the association between PTSD and CVD risk. This finding is consistent with previous notions that the link between PTSD and CVD risk is mediated by the sympathetic nervous system and neuroendocrine and inflammatory factors, which are also associated with smoking, sleep, medical, and other psychiatric disorders. Though previous studies adjusted for similar covariates, the time-dependent covariate analysis may have allowed long-enduring factors to have stronger effects. The results cannot be generalized to non-VA populations or people over age 70.

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