Post-Traumatic Stress Disorder and Incidence of Coronary Heart Disease

• Type of Material: Article
• Authors: Viola Vaccarino, Emory University; Jack Goldberg, University of Washington; Cherie Rooks, Emory University; Amit J. Shah, Emory University; Emir Veledar, Emory University; Tracy L. Faber, Emory University; John R Votaw, Emory University; Christopher W. Forsberg, University of Washington; J. Douglas Bremner, Emory University
• Language: English
• Date: 2013-09-10
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2013.04.085
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 62
• Issue: 11
• Start Page: 970
• End Page: 978
• Grant/Funding Information: Also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454; and by the Emory University General Clinical Research Center MO1-RR00039.; The United States Department of Veterans Affairs has provided financial support for the development and maintenance of the Vietnam Era Twin (VET) Registry.; This work was supported by the National Institutes of Health (K24HL077506; R01 HL68630; R01 AG026255; NIH K24 MH076955; R21HL093665-01A1S1); and by the American Heart Association (0245115N).
• Keywords: PHYSICAL HEALTH; Cardiovascular System & Cardiology; MORTALITY; cardiovascular diseases; CARDIOVASCULAR-DISEASE; COMBAT; risk factors; Cardiac & Cardiovascular Systems; MYOCARDIAL-INFARCTION; epidemiology; FLOW RESERVE; Life Sciences & Biomedicine; POSITRON-EMISSION-TOMOGRAPHY; PROGNOSTIC VALUE; Science & Technology; stress; VIETNAM VETERANS; WAR VETERANS
• Research Categories: Health Sciences, Epidemiology; Psychology, Clinical; Health Sciences, Medicine and Surgery

Abstract

Objectives: The aim of this study was to determine whether post-traumatic stress disorder (PTSD) is associated with coronary heart disease (CHD) using a prospective twin study design and objective measures of CHD. Background: It has long been hypothesized that PTSD increases the risk of CHD, but empirical evidence using objective measures is limited. Methods: We conducted a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Among twin pairs without self-reported CHD at baseline, we selected pairs discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition. All underwent a clinic visit after a median follow-up of 13 years. Outcomes included clinical events (myocardial infarction, other hospitalizations for CHD and coronary revascularization) and quantitative measures of myocardial perfusion by [ 13N] ammonia positron emission tomography, including a stress total severity score and coronary flow reserve. Results: A total of 562 twins (281 pairs) with a mean age of 42.6 years at baseline were included in this study. The incidence of CHD was more than double in twins with PTSD (22.6%) than in those without PTSD (8.9%; p < 0.001). The association remained robust after adjusting for lifestyle factors, other risk factors for CHD, and major depression (odds ratio: 2.2; 95% confidence interval: 1.2 to 4.1). Stress total severity score was significantly higher (+95%, p = 0.001) and coronary flow reserve was lower (-0.21, p = 0.02) in twins with PTSD than in those without PTSD, denoting worse myocardial perfusion. Associations were only mildly attenuated in 117 twin pairs discordant for PTSD. Conclusions: Among Vietnam-era veterans, PTSD is a risk factor for CHD.