Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Feb 19;8(4):e011133.
doi: 10.1161/JAHA.118.011133.

Comorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease

Jeffrey F Scherrer  1   2 , Joanne Salas  1   2 , Beth E Cohen  3 , Paula P Schnurr  4 , F David Schneider  5 , Kathleen M Chard  6 , Peter Tuerk  7 , Matthew J Friedman  4 , Sonya B Norman  8 , Carissa van den Berk-Clark  1 , Patrick J Lustman  9
Affiliations
Multicenter Study

Comorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease

Jeffrey F Scherrer et al. J Am Heart Assoc. .

Abstract

Background Posttraumatic stress disorder ( PTSD ) is associated with risk of cardiovascular disease ( CVD ). Biopsychosocial factors associated with PTSD likely account for some or all of this association. We determined whether 1, or a combination of comorbid conditions explained the association between PTSD and incident CVD . Methods and Results Eligible patients used 1 of 5 Veterans Health Affairs medical centers distributed across the United States. Data were obtained from electronic health records. At index date, 2519 Veterans Health Affairs ( VA ) patients, 30 to 70 years of age, had PTSD diagnoses and 1659 did not. Patients had no CVD diagnoses for 12 months before index date. Patients could enter the cohort between 2008 and 2012 with follow-up until 2015. Age-adjusted Cox proportional hazard models were computed before and after adjusting for comorbidities. Patients were middle aged (mean=50.1 years, SD ±11.0), mostly male (87.0%), and 60% were white. The age-adjusted association between PTSD and incident CVD was significant (hazard ratio=1.41; 95% CI : 1.21-1.63). After adjustment for metabolic conditions, the association between PTSD and incident CVD was attenuated but remained significant (hazard ratio=1.23; 95% CI : 1.06-1.44). After additional adjustment for smoking, sleep disorder, substance use disorder, anxiety disorders, and depression, PTSD was not associated with incident CVD (hazard ratio=0.96; 95% CI : 0.81-1.15). Conclusions PTSD is not an independent risk factor for CVD . Physical and psychiatric conditions and smoking that co-occur with PTSD explain why this patient population has an increased risk of CVD . Careful monitoring may limit exposure to CVD risk factors and subsequent incident CVD .

Keywords: cardiovascular disease; epidemiology; posttraumatic stress disorder; veterans.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Eligibility criteria. CVD indicates cardiovascular disease; FY, fiscal year; PTSD, posttraumatic stress disorder.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Koenen KC, Sumner JA, Gilsanz P, Glymour MM, Ratanatharathorn A, Rimm EB, Roberts AL, Winning A, Kubzansky LD. Post‐traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice. Psychol Med. 2017;47:209–225. - PMC - PubMed
    1. Boscarino JA. A prospective study of PTSD and early‐age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Psychosom Med. 2008;70:668–676. - PMC - PubMed
    1. Boscarino JA. Post‐traumatic stress disorder and cardiovascular disease link: time to identify specific pathways and interventions. Am J Cardiol. 2011;108:1052–1053. - PubMed
    1. Vaccarino V, Goldberg J, Rooks C, Shah AJ, Veledar E, Faber TL, Votaw JR, Forsberg CW, Bremner JD. Clinical research: post‐traumatic stress disorder and incidence of coronary heart disease. A twin study. J Am Coll Cardiol. 2013;62:970–978. - PMC - PubMed
    1. Sumner JA, Kubzansky LD, Elkind MSV, Roberts AL, Agnew‐Blais J, Chen Q, Cerdá M, Rexrode KM, Rich‐Edwards JW, Spiegelman D, Suglia SF, Rimm EB, Koenen KC. Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation. 2015;132:251–259. - PMC - PubMed

Publication types