Clinical Implications
In terms of clinical implications, study authors suggest that longer duration of exposure to CVD risk factors, such as smoking, among patients with PTSD might increase the risk of cardiac events. On the other hand, early detection and effective management of hypertension, Type 2 diabetes mellitus, depression, anxiety, sleep disorders and other CVD risk factors could help mitigate the elevated risk.
Background information in the article pointed out that PTSD is associated with a range of biological, psychological, and behavioral correlates that could help explain the association between PTSD and CVD. Those include:
- PTSD can result in hypothalamic–pituitary–adrenal axis dysfunction, increased inflammation and abnormal cortisol regulation, which increases risk of hypertension, diabetes mellitus and CVD similar to the process observed in patients with depression.
- Poor coping strategies involve heavy smoking, excessive alcohol use and illicit drug use, which might contribute to increased risk of CVD.
- Depression and other anxiety disorders are frequently comorbid with PTSD, and depression and some anxiety disorders have been identified as CVD risk factors.
Researchers reported that younger patients were more likely to have PTSD (P<0.0001), while white race was less common and black race was more common among patients with the condition.
Significantly more common among PTSD patients were depression, other anxiety disorder, sleep disorders and substance use disorder, according to the study. But so were T2DM, obesity, hypertension and hyperlipidemia, researchers pointed out, adding that significantly higher average body mass index was observed in patients with PTSD and the percent of patients with a body mass index of 30 or higher was significantly higher in those with vs. without PTSD. Those with PTSD diagnoses also were much more likely to be current smokers.
The study found that, during follow‐up, 782 patients developed CVD. Of these cases, 10.5% were incident hypertensive heart disease diagnoses, 6.8% myocardial infarction, 29.8% ischemic heart disease, 4.2% diseases of pulmonary circulation and 56.0% “other” heart disease diagnoses. Multiple components of incident CVD were identified in 6.4% of the patients.
“In a large sample of VHA patients, we observed that patients diagnosed with PTSD from Sept. 30, 2008, to October 1, 2012, and followed up through 2015, were 41% more likely than those without PTSD to develop CVD,” study authors wrote. “Physical comorbidities partially explained this association. After adjusting for these conditions, the magnitude of the association between PTSD and incident CVD was reduced by 44% but remained statistically significant (HR=1.23; 95% CI: 1.06–1.44).”
The researchers recommended closer monitoring of physical and psychiatric disorders might be warranted in PTSD patients, as well as a smoking cessation program.
“Additionally, PTSD itself can be effectively treated and further research is needed to determine whether PTSD remission is associated with fewer comorbidities and lower CVD risk,” they concluded. “Recognizing that PTSD does not preordain CVD may empower patients to seek care to prevent and/or manage CVD risk factors. Patients without PTSD are also at risk of CVD if they smoke, have a sleep disorder, depression, or metabolic disease. In both patient populations, the risk of CVD can be mitigated with health behavior change and effective chronic disease management.”
Scherrer JF, Salas J, Cohen BE, Schnurr PP, et. Al. Comorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease. J Am Heart Assoc. 2019 Feb 19;8(4):e011133. doi: 10.1161/JAHA.118.011133. PubMed PMID: 30755078.
