LOS ANGELES—While post-traumatic stress disorder in veterans previously has been linked to heart disease, the cohorts used in those studies were overwhelmingly mail. Now, a new study took a close look at PTSD’s effect on heart health in women veterans—and the news wasn’t good.
A presentation at the American Heart Association’s Scientific Sessions 2019 in Philadelphia determined that female veterans with PTSD have more heart disease risk factors, including obesity, at younger ages than female veterans without the condition.1
“Since PTSD and heart disease can present differently in men and women, we wanted to assess the prevalence of heart disease risk factors in female veterans to better understand any correlation of PTSD to heart disease unique to this population,” explained lead author Ramin Ebrahimi, MD, a clinical professor of medicine at the University of California Los Angeles and a staff cardiologist at the Greater Los Angeles VA Health System. “We looked at the national Veterans Administration electronic database and found that female veterans with PTSD had higher rates of diabetes, high cholesterol, high blood pressure, tobacco smoking and obesity compared to women veterans who did not have PTSD.”
The study noted that, despite sex differences in the prevalence and pathophysiology of both PTSD and coronary artery disease, little research has been conducted on the association between the two in women veterans. Researchers sought to evaluate the prevalence of CAD risk factors in women veterans, positing that those with PTSD would be at greater risk.
The cross-sectional study used data from the VA’s nationwide corporate data warehouse to identify women veterans visiting any VAMC between fiscal year 2000 and FY2017. The study team used International Classification of Disease codes to identify patients with records of PTSD and CAD risk factors, including hyperlipidemia, hypertension, Type 2 diabetes, tobacco use) and obesity.
The study determined that 728,373 women veterans with an average age of 52.0 years (standard deviation: 16.9) visited the VA during that time period. Of these 172,096 (23.6%) had a PTSD diagnosed.
Even though patients with PTSD were significantly younger than those without PTSD (47.3 vs. 53.5, p <0.05), those veterans also had significantly higher unadjusted and age-standardized prevalence rates for all CAD risk factors and obesity.
Researchers calculated the age adjusted SSRs as:
- 32 (95% confidence interval 1.31-1.34) for hyperlipidemia,
- 37 (1.36-1.38) for hypertension,
- 55 (1.53-1.57) for Type 2 diabetes,
- 75 (1.74-1.76) for tobacco use, and
- 53 (1.52-1.54) for obesity.
“Women veterans with PTSD have significantly higher rates of CAD risk factors and obesity at a younger age compared to those without PTSD,” the authors concluded. “Given the growing number of Women Veterans, these findings can have practice implications for early and routine CAD risk factor screening in this high-risk population. Further investigation is indicated to understand the role of PTSD as an independent risk factor for CAD in women veterans.”
“Having higher rates of heart disease risk factors could put female veterans with PTSD at increased risk for developing heart disease,” Ebrahimi added. “Healthcare providers may need to watch these women more closely at a younger age and treat them more aggressively than those without PTSD to decrease their risk of heart disease.”
He emphasized that it is not yet clear whether PTSD by itself increases risk of heart disease or if risk of heart disease is higher in patients with PTSD because they have more risk factors.
“Our study will continue and hopefully will answer this question, too,” Ebrahimi said.
- Ebrahimi R, Summer J, Lynch K, Viernes B, et. al. Sex and Gender Influences on Patient and Provider Outcomes. Poster presented at American Heart Association’s Scientific Sessions 2019, November 16-18 in Philadelphia, PA.