Late Breaking News
VA Study - Stress Can Increase Inflammation and Worsen Cardiovascular Disease in Patients
- Categorized in: Department of Veterans Affairs (VA), May 2012, News, PTSD, Rheumatology, TBI, Trauma
By Stephen Spotswood
SAN FRANCISCO — New VA research suggests that lifetime exposure to stressful events, such as those which cause PTSD, is linked to greater levels of inflammation in patients with cardiovascular (CV) disease. Higher inflammation generally leads to worse outcomes for patients.
The study was conducted by researchers at the San Francisco VA Medical Center (VAMC) and used data from patients enrolled in the Heart and Soul Study — an ongoing investigation into the links between heart disease and psychological factors, such as depression. Heart and Soul, which is based at the San Francisco VAMC and the Palo Alto VA, has been following a cohort of 1,024 veterans for the past 10 years.
This newest research, conducted in partnership with the University of San Francisco and published electronically in the journal Brain, Behavior, and Immunity, studied exposures in 979 patients for 18 different types of traumatic events — the kind most likely to occur on the battlefield, and all involving experiencing or witnessing a direct threat to life or limb. All of the patients were between the ages of 45 to 90 and had been diagnosed with heart disease.
Once researchers learned what kind of trauma had affected each patient, they looked for markers in the patients’ bloodstream that would suggest inflammation. They found clinical markers, such as interleukin, tumor necrosis factor alpha, C-reactive protein and resistin in higher levels among patients who had been exposed to the greatest levels of traumatic psychological stress.
When investigators went back to the patients five years later, they found that the same patients with the greatest stress levels still had the highest level of inflammation. While inflammation did increase between baseline and follow-up, there was no link between rate of increase and level of psychological stress.
After adjusting for sociodemographic factors, psychiatric disorders and other health behaviors, the link between inflammation and stress remained.
“Not everyone who is exposed to trauma develops PTSD,” said senior investigator Beth Cohen, MD, a physician at the San Francisco VAMC. “This study emphasizes that traumatic stress can have a long-term negative impact on your health, even if you don’t go on to develop PTSD. It also tells us that, as clinicians, we need to think about not just which diagnostic box someone might fit into but what their lifetime trauma exposure has been.”
What the study did not investigate is why exactly this link exists. For that, further research will be needed. One possible explanation put forward by investigators is that the link is caused by a heightened sensitivity to threats in patients who have experienced traumatic stress. This heightened sensitivity — meant to be a survival mechanism — would actually work against the patient, increasing inflammatory response.
However the mechanism works, researchers hope that, with early intervention, inflammation can be prevented or lessened.
Cohen noted that “this is a study of older people, and the cumulative effects that decades of traumatic experiences have on their bodies. If we could intervene with young people using techniques that we know help fight stress, such as exercise, yoga and other integrative health techniques, it would be interesting to know if we might be able to prevent some of this."
The study is the latest to find a possible link between traumatic stress and physical-health conditions. In January, VA’s National Center for Posttraumatic Stress Disorder (NCPTSD) presented findings from the latest wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The survey found that past-year medical conditions were associated with lifetime trauma exposure and full or partial PTSD.
Patients with PTSD were more likely to have been diagnosed with physical ailments, including hypertension, angina pectoris, tachycardia, other heart disease, stomach ulcer, gastritis and arthritis. They also scored lower on measures of physical functioning than those without a history of trauma.
NESARC is a longitudinal survey of 43,000 Americans first conducted in 2001, followed by a second wave completed in 2005. The survey results are one data set being used by NCPTSD researchers to examine the long-term burden of trauma.
The San Francisco VAMC study was published online in the journal Brain, Behavior and Immunity. The NCPTSD findings were published online in the Journal of the American Geriatrics Society.