Traumatic Events, PTSD Raise CVD Risk in Women

Women who suffer traumatic events or develop posttraumatic stress disorder (PTSD) are at increased risk of developing cardiovascular disease (CVD), according to new data from a long-running study of US nurses.

"PTSD is not exclusively a psychological problem but also increases risk of chronic disease," lead author Jennifer A. Sumner, PhD, of Columbia University Mailman School of Public Health, in New York City, told Medscape Medical News.

"Treatment providers serving individuals at risk for PTSD, including primary care physicians, should screen for cardiovascular risk and monitor health behaviors in those with PTSD. Psychological treatment for PTSD also needs to consider the long-term health consequences of the disorder. Ultimately, integration of mental and physical healthcare is key," Dr Sumner added.

The study was published online June 29 in Circulation.

Mind-Body Connection

The researchers assessed trauma exposure and PTSD symptoms in relation to incident CVD during 2 decades in nearly 50,000 women in the Nurses' Health Study II. During that time, 548 probable or definite CVD events were logged, including 277 myocardial infarctions and 271 strokes.

After adjusting for age, family history, and childhood factors, women reporting four or more PTSD symptoms had 60% higher rates of developing CVD compared with women who were not exposed to traumatic events (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.20 - 2.13).

Women who were exposed to trauma but who had no PTSD symptoms were also at heightened risk for CVD compared with those who were not exposed to trauma (HR, 1.45; 95% CI, 1.15 - 1.83).

Unhealthy behaviors, including lack of exercise and obesity, and medical risk factors, including hypertension and use of hormone replacement therapy, accounted for 47% of the association between elevated PTSD symptoms and CVD and about 14% of the association between trauma/no PTSD and CVD.

"Stress has long been thought to increase risk of cardiovascular disease, and PTSD is the quintessential stress-related mental disorder," Dr Sumner commented. "PTSD is twice as common in women as in men; approximately 1 in 10 women will develop PTSD in their lifetime. Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men. Our study is the first to look at trauma exposure and PTSD symptoms and new cases of CVD in a general population sample of women," she said.

Screen for PTSD

Commenting on the findings for Medscape Medical News, Suzanne Steinbaum, MD, director, Women's Heart Health, Heart and Vascular Institute, Lenox Hill Hospital, New York City, and a spokesperson for the American Heart Association, said the study is another in a series highlighting the significant impact of emotion on the heart, especially in women.