Trauma, PTSD may be risk factors for cardiovascular disease among women
Data from the Nurses’ Health Study II indicate that female nurses who experienced trauma and elevated PTSD symptoms were more likely to develop cardiovascular disease.
“Psychological stress has long been hypothesized to be a risk factor for [cardiovascular disease], and exposure to extremely stressful or traumatic events, such as childhood adversity and combat, has been linked to increased [cardiovascular disease] risk,” study researcher Jennifer Sumner, PhD, of the Mailman School of Public Health at Columbia University, and colleagues wrote in Circulation. “Despite emerging findings on stress-related mental disorders and [cardiovascular disease], the understanding of whether PTSD increases risk of [cardiovascular disease] is limited in important ways.”
To address this limitation, Sumner and colleagues assessed data from the Nurses’ Health Study II, which includes 116,430 women who enrolled in 1989 and are followed biennially. This study includes 49,978 women, aged 44 to 62 years, who participated in a supplemental questionnaire about trauma exposure and PTSD symptoms in 2008. The women indicated if they had ever experienced a physician diagnosed myocardial infarction (MI), angina, stroke or transient ischemic attack at baseline and at each biennial follow-up.
At baseline, 30% of women reported they did not experience any traumatic events at or before baseline, approximately 50% were considered to have experienced trauma without PTSD symptoms, 9.5% were considered to have experienced trauma with one to three PTSD symptoms and 9.5% were considered to have experienced trauma with four or more PTSD symptoms.
Exposure to trauma and PTSD symptoms were associated with higher rates of cigarette smoking, family history of MI and stroke and reporting highest somatotype at age 5 years.
An additional 4,372 women reported trauma exposure during follow-up.
Between 1989 and 2009, 548 probable or definite cardiovascular disease (CVD) events occurred.
Exposure to trauma with no PTSD symptoms was associated with increased risk for CVD events (HR = 1.45; 95% CI, 1.15-1.83), while trauma exposure with one to three PTSD symptoms was not.
Experiencing trauma with four or more PTSD symptoms was associated with the highest increased risk for CVD events (HR = 1.6; 95% CI, 1.2-2.13).
These associations remained when adjusting for adult health behaviors and medical risk factors, which accounted for 14% of the association between CVD risk and trauma with no symptoms and 47% of the association between CVD risk and trauma with four or more symptoms, according to researchers.
“Currently, neither the American Heart Association nor the American Stroke Association recognizes trauma or PTSD as risk factors for CVD, and there is no systematic approach for addressing CVD risk factors in trauma-exposed individuals with or without PTSD,” Sumner and colleagues wrote. “Our findings, together with those in the literature, suggest that PTSD may be a modifiable risk factor for CVD. Additional research on the mechanisms underlying the relations between trauma, PTSD and CVD will help to elucidate the understanding of these associations.” – by Amanda Oldt
Disclosure: The researchers report no relevant financial disclosures.