The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis

Abstract

Objective: People with posttraumatic stress disorder (PTSD) have a higher mortality than the general population, mainly due to cardiovascular diseases (CVD). Metabolic syndrome (MetS) and its components are highly predictive of CVD. The aim of this meta-analysis was to describe pooled frequencies of MetS and its components in people with PTSD and to compare MetS prevalence in PTSD versus the general population.

Method: Medline, PsycARTICLES, Embase and CINAHL were searched until 02/2015 for cross-sectional and baseline data of longitudinal studies in adults with PTSD. Two independent reviewers conducted the searches and extracted data. Random effects meta-analysis with a relative risk, subgroups and meta-regression analyses were employed.

Results: Overall, 9 studies met the inclusion criteria including 9,673 individuals in midlife with PTSD and 6852 general population controls. The pooled MetS prevalence was 38.7% (95% CI = 32.1%-45.6%; Q = 52.1, p < 0.001; N = 9; n = 9,673; age range = 44-61 years). Abdominal obesity was observed in 49.3% (95% CI = 29.7%-69.0%), hyperglycemia in 36.1% (95% CI = 18.8%-55.6%), hypertriglyceridemia in 45.9% (95% CI = 12.2%-81.9%), low high density-lipoprotein-cholesterol in 46.4% (95% CI = 26.4%-67.0%) and hypertension in 76.9% (95% CI = 67.9%-84.8%). The MetS prevalence was consistently high across geographical regions, settings or populations (war veterans or not). Compared with matched general population controls, people with PTSD had an almost double increased risk for MetS (RR = 1.82; 95% CI = 1.72-1.92; p < 0.001). Most analyses were not statistically heterogeneous.

Conclusions: MetS is highly prevalent in people with PTSD. Routine screening and multidisciplinary management of medical and behavioral conditions is needed. Future research should focus on how cardio-metabolic outcomes are moderated by clinical and treatment characteristics and genetic factors.

Keywords: Cardiovascular disease; Glucose; Lipids; Metabolic syndrome; PTSD.