Study Urges Close Monitoring of Physical, Psychological Co-Morbidities

ST. LOUIS—Even though veterans diagnosed with post-traumatic stress disorder are 41% more likely to developing cardiovascular disease than those without, PTSD alone doesn’t fully explain the higher risk, according to a study.

Instead, researchers suggest that a combination of physical disorders, psychiatric disorders and smoking—all more common in patients with PTSD—share the blame.

The study in the Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association, looked at whether one condition, or a combination of heart disease risk factors often identified in patients with PTSD, can explain the association between CVD and the traumatic stress condition.

To reach that conclusion, Saint Louis University School of Medicine-led researchers reviewed electronic health records of 2,519 VA patients diagnosed with PTSD and 1,659 without PTSD. Participants were aged 30-70, 87% male and 60% white. Participants had no record of cardiovascular disease diagnoses for at least a year prior to the study and were followed for at least three years.

Results indicated that, among VA patients, those diagnosed with PTSD were 41% more likely to develop circulatory and heart disease than those without PTSD. The study also found that smoking, depression, other anxiety disorders, sleep disorders, Type 2 diabetes, obesity, high blood pressure and elevated cholesterol all were significantly more prevalent among patients with PTSD than those without.

Yet, researchers weren’t able to pinpoint a single comorbid condition that explained the association between PTSD and incident cardiovascular disease. In fact, after adjusting for a combination of physical and psychiatric disorders, smoking, sleep disorder, substance use disorders, PTSD was not associated with new cases of cardiovascular disease.

“This suggests there is no single comorbidity or behavior that explains the link between PTSD and cardiovascular disease,” explained lead author Jeffrey Scherrer, Ph.D., professor and director, Division of Research in the Department of Family and Community Medicine at the Saint Louis University School of Medicine in Missouri. “Instead, a combination of physical disorders, psychiatric disorders and smoking—that are more common in patients with PTSD vs. without PTSD—appear to explain the association between PTSD and developing cardiovascular disease.”

Results might not be generalizable to patients older than 70 or to nonveteran populations, researchers cautioned. The authors added that their study did not measure lifetime cardiovascular disease risk and that a long-term study might have different results.

“For veterans, and likely nonveterans, heart disease prevention efforts should focus on helping patients reduce weight, control high blood pressure, cholesterol, Type 2 diabetes, depression, anxiety disorders, sleep problems, substance abuse and smoking,” Scherrer said. “That is a long list, and for patients with many of these conditions it is challenging, yet important, to manage all of them.”

“Recognizing that PTSD does not preordain cardiovascular disease may empower patients to seek care to prevent and/or manage CVD risk factors,” he added.

The study included participation from the San Francisco and Cincinnati VAMCs, as well as the National Center for PTSD.

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