In the Journals

PTSD increases long-term MI, stroke risk in World Trade Center response crews

PTSD increased the risk for MI and stroke independent of depression among workers involved in the cleaning of debris at ground zero after 9/11, according to a study published in Circulation: Cardiovascular Quality and Outcomes.

“PTSD’s association with heart attack and stroke should be taken into consideration when untrained first responders are sent to respond to catastrophes of different types,” Alfredo Morabia, MD, PhD, professor of epidemiology at City University of New York and Columbia University Mailman School of Public Health, said in a press release. “Heart attack and stroke should be considered a related disease in World Trade Center first responders and it should be incorporated along with their benefits and care.”

Molly Remch, study coordinator of the WTC Heart Study at the Research Foundation of City University of New York, and colleagues analyzed data from 5,971 first responders (82.8% men; mean age, 51 years) from the World Trade Center-Heart study who helped in the cleanup of the World Trade Center complex in 2001 and 2002 after 9/11. Participation in cleanup efforts were self-reported through detailed questionnaires. Patients attended one of their annual clinical visits within the World Trade Center Health Program between 2012 and June 2013.

CV risk factors that were recognized in this study included a comprehensive smoking history, two standardized BP measurements, blood lipids, body weight and height. Mental health symptoms were also assessed at baseline.

Patients were followed up between 2012 and June 2016 by mail, online or telephone and included a standardized, self-administered survey about incident cardiac or neurological events.

In the cohort, 25.9% of women and 19.9% of men had PTSD. Both men and women with PTSD had a larger cumulative incidence of stroke or MI.

The adjusted HR for stroke was 2.51 (95% CI, 1.39-4.57) and 2.22 for MI (95% CI, 1.3-3.82). When MI and stroke were pooled together, the adjusted HR was 2.35 for all patients (95% CI, 1.57-3.52) and 1.88 in men free from depression (95% CI, 1.01-3.49).

When hospitalization registry data were reviewed, the adjusted HR was 3.01 for stroke (95% CI, 1.84-4.93) and 2.17 for MI (95% CI, 1.41-3.32). The adjusted HR for pooled MI and stroke was 2.4 in all patients (95% CI, 1.73-3.34), 2.44 in women (95% CI, 1.05-5.55) and 2.27 in men free from depression (95% CI, 1.41-3.67).

Dust exposure from the World Trade Center did not affect the incidence of stroke or MI.

“In humans, the stress associated with these PTSD dimensions may upregulate amygdalar activity, activating both the sympathetic nervous system, releasing inflammatory cells from the bone marrow and leading to atherosclerotic inflammation, MI and stroke,” Remch and colleagues wrote. “The similar effect sizes in this study suggest similar mechanisms relating PTSD and incident MI or stroke in men and women.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

PTSD increased the risk for MI and stroke independent of depression among workers involved in the cleaning of debris at ground zero after 9/11, according to a study published in Circulation: Cardiovascular Quality and Outcomes.

“PTSD’s association with heart attack and stroke should be taken into consideration when untrained first responders are sent to respond to catastrophes of different types,” Alfredo Morabia, MD, PhD, professor of epidemiology at City University of New York and Columbia University Mailman School of Public Health, said in a press release. “Heart attack and stroke should be considered a related disease in World Trade Center first responders and it should be incorporated along with their benefits and care.”

Molly Remch, study coordinator of the WTC Heart Study at the Research Foundation of City University of New York, and colleagues analyzed data from 5,971 first responders (82.8% men; mean age, 51 years) from the World Trade Center-Heart study who helped in the cleanup of the World Trade Center complex in 2001 and 2002 after 9/11. Participation in cleanup efforts were self-reported through detailed questionnaires. Patients attended one of their annual clinical visits within the World Trade Center Health Program between 2012 and June 2013.

CV risk factors that were recognized in this study included a comprehensive smoking history, two standardized BP measurements, blood lipids, body weight and height. Mental health symptoms were also assessed at baseline.

Patients were followed up between 2012 and June 2016 by mail, online or telephone and included a standardized, self-administered survey about incident cardiac or neurological events.

In the cohort, 25.9% of women and 19.9% of men had PTSD. Both men and women with PTSD had a larger cumulative incidence of stroke or MI.

The adjusted HR for stroke was 2.51 (95% CI, 1.39-4.57) and 2.22 for MI (95% CI, 1.3-3.82). When MI and stroke were pooled together, the adjusted HR was 2.35 for all patients (95% CI, 1.57-3.52) and 1.88 in men free from depression (95% CI, 1.01-3.49).

When hospitalization registry data were reviewed, the adjusted HR was 3.01 for stroke (95% CI, 1.84-4.93) and 2.17 for MI (95% CI, 1.41-3.32). The adjusted HR for pooled MI and stroke was 2.4 in all patients (95% CI, 1.73-3.34), 2.44 in women (95% CI, 1.05-5.55) and 2.27 in men free from depression (95% CI, 1.41-3.67).

Dust exposure from the World Trade Center did not affect the incidence of stroke or MI.

“In humans, the stress associated with these PTSD dimensions may upregulate amygdalar activity, activating both the sympathetic nervous system, releasing inflammatory cells from the bone marrow and leading to atherosclerotic inflammation, MI and stroke,” Remch and colleagues wrote. “The similar effect sizes in this study suggest similar mechanisms relating PTSD and incident MI or stroke in men and women.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.