Among veterans, PTSD-CVD link is explained by comorbidities

  • Scherrer JF & al.
  • J Am Heart Assoc
  • 19 Feb 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For veterans, the association of posttraumatic stress disorder (PTSD) and incident cardiovascular disease (CVD) appears to be mediated by physical and psychiatric disorders and smoking.
  • Authors: “Recognizing that PTSD does not preordain CVD may empower patients to seek care to prevent and/or manage CVD risk factors.”

Why this matters

  • PTSD is a risk factor for CVD.
  • Correlates in patients with PTSD such as abnormal cortisol regulation, increased inflammation, heavy smoking, and depression could explain the association. 

Key results

  • CVD rate among patients with vs without PTSD: 46.7 vs 33.3 per 1000 person-years (P<.0001>
  • After extensive adjustment for physical, psychiatric, and behavioral conditions:
    • Association between PTSD and CVD disappeared: HR, 0.96 (95% CI, 0.81-1.15).
    • PTSD was also not associated with all-cause mortality: HR, 0.83 (95% CI, 0.59-1.28).

Study design

  • Analysis of electronic health records at 5 US Veterans Health Affairs hospitals, 2008-2012; observation until 2015. 
  • Participants were aged 30-70 years (n=11,856; n=5940 with PTSD).
  • Authors followed patients with and without PTSD, adjusting for numerous covariates. 
  • Outcome: incident CVD.
  • Funding: NIH.

Limitations

  • Maximum follow-up was 8 years, but CVD could have developed later.
  • Most patients were middle-aged men.