Background
Patients with posttraumatic stress disorder (PTSD) are at increased risk for cardiovascular
disease (CVD), but few studies have included objective measures of CVD and how PTSD
causes CVD remains unknown. We sought to determine the association between PTSD and
objectively assessed CVD and examine potential underlying mechanisms.
Methods
Outpatients from two Veterans Affairs Medical Centers were enrolled from 2008 to 2010.
Posttraumatic stress disorder was identified using the Clinician Administered PTSD
Scale, and standardized exercise treadmill tests were performed to detect myocardial
ischemia.
Results
Of the 663 participants with complete data, ischemia was present in 17% of patients
with PTSD versus 10% of patients without PTSD (p = .006). The association between PTSD and ischemia remained significant after adjusting
for potential confounders (age, sex, prior CVD) and mediators (traditional cardiac
risk factors, C-reactive protein, obesity, alcohol use, sleep quality, social support,
and depression), adjusted odds ratio (OR) 2.42, 95% confidence interval (CI) 1.39
to 4.22, p = .002. Findings remained significant when those with prior CVD were excluded (fully
adjusted OR 2.24, 95% CI 1.20–4.18, p = .01) and when continuous PTSD symptom score was used as the predictor (fully adjusted
OR per 10-point change in Clinician Administered PTSD Scale score 1.12, 95% CI 1.03–1.22,
p = .01).
Conclusions
Posttraumatic stress disorder was associated with ischemic changes on exercise treadmill
tests independent of traditional cardiac risk factors, C-reactive protein, and several
health behaviors and psychosocial risk factors, suggesting additional mechanisms linking
PTSD and ischemia should be explored. The association of PTSD and ischemia among patients
without known CVD highlights an opportunity for early interventions to prevent progression
of cardiovascular disease.
Key Words
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Article Info
Publication History
Published online: August 26, 2013
Accepted:
July 2,
2013
Received in revised form:
June 28,
2013
Received:
November 8,
2012
Identification
Copyright
Published by Elsevier Inc.
