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Author Notes:

Correspondence to Dr Jaimie L Gradus; Jaimie.gradus@va.gov

All authors made substantial contributions to the design of the study, and interpretation of the data. DKF and ES made substantial contributions to the acquisition and analysis of data. All authors contributed to the drafting of the current manuscript, and gave final approval of this version.

Competing interests: None declared.


Research Funding:

his work was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation, and the Aarhus University Research Foundation, and by a National Institute of Mental Health grant: ‘Constructing a Danish Reaction to Severe Stress Cohort’ (1R21MH094551-01A1), JLG, Principal Investigator.


  • Mental health
  • Cardiology
  • Epidemiology

Associations between stress disorders and cardiovascular disease events in the Danish population


Journal Title:

BMJ Open


Volume 5, Number 12


, Pages e009334-e009334

Type of Work:

Article | Final Publisher PDF


Objectives: Post-traumatic stress disorder (PTSD) is a well-documented risk factor for cardiovascular disease (CVD). However, it is unknown whether another common stress disorder—adjustment disorder—is also associated with an increased risk of CVD and whether gender modifies these associations. The aim of this study was to examine the overall and gender-stratified associations between PTSD and adjustment disorder and 4 CVD events. Design: Prospective cohort study utilising Danish national registry data. Setting: The general population of Denmark. Participants: PTSD (n=4724) and adjustment disorder (n=64 855) cohorts compared with the general population of Denmark from 1995 to 2011. Primary outcome measures: CVD events including myocardial infarction (MI), stroke, ischaemic stroke and venous thromboembolism (VTE). Standardised incidence rates and 95% CIs were calculated. Results: Associations were found between PTSD and all 4 CVD events ranging from 1.5 (95% CI 1.1 to 1.9) for MI to 2.1 (95% CI 1.7 to 2.7) for VTE. Associations that were similar in magnitude were also found for adjustment disorder and all 4 CVD events: 1.5 (95% CI 1.4 to 1.6) for MI to 1.9 (95% CI 1.8 to 2.0) for VTE. No gender differences were noted. Conclusions: By expanding beyond PTSD and examining a second stress disorder—adjustment disorder—this study provides evidence that stress-related psychopathology is associated with CVD events. Further, limited evidence of gender differences in associations for either of the stress disorders and CVD was found.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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