Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study.
BACKGROUND
Various correlates of posttraumatic stress disorder (PTSD), such as high levels of sympathetic activation and hypothalamic-pituitary-adrenal axis dysregulation, have been linked to arterial damage and coronary heart disease (CHD) risk. While psychological disturbance is frequently found among patients with cardiac disease, whether psychological problems precede or occur as a result of having a potentially fatal disease is not clear. To our knowledge, no prospective studies to date have evaluated whether PTSD is associated with increased risk of CHD.


OBJECTIVE
To test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using 2 different measures of PTSD.


METHODS
Prospective cohort study.


METHODS
Community-dwelling men from the Greater Boston, Mass, area who served in the military.


METHODS
Data are from the Veterans Affairs Normative Aging Study. Men who completed either the Mississippi Scale for Combat-Related PTSD in 1990 (n = 1002) or the Keane PTSD scale in 1986 (n = 944) were included in the study.


METHODS
Incident CHD occurring during follow-up through May 2001.


RESULTS
Levels of PTSD symptoms in this cohort were low to moderate. Men with preexisting CHD at baseline were excluded, and PTSD was measured with the Mississippi Scale for Combat-Related PTSD. For each SD increase in symptom level, men had age-adjusted relative risks of 1.26 (95% confidence interval, 1.05-1.51) for nonfatal myocardial infarction and fatal CHD combined and 1.21 (95% confidence interval, 1.05-1.41) for all of the CHD outcomes combined (nonfatal myocardial infarction, fatal CHD, and angina). Findings were replicated using the Keane PTSD scale and somewhat strengthened after controlling for levels of depressive symptoms.


CONCLUSIONS
To our knowledge, this is the first study to demonstrate a prospective association between PTSD symptoms and CHD even after controlling for depressive symptoms. These results suggest that a higher level of PTSD symptoms may increase the risk of incident CHD in older men.
Kubzansky
Laura D
LD
Harvard School of Public Health, Veterans Affairs Normative Aging Study, Veterans Affairs Boston Health Care System, Boston University School of Medicine, 677 Huntington Avenue, Boston, MA 02115, USA. lkubzans@hsph.harvard.edu
Koenen
Karestan C
KC
Spiro
Avron
A
Vokonas
Pantel S
PS
Sparrow
David
D
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D002423:Cause of Death; D015331:Cohort Studies; D003130:Combat Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D008950:MMPI; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology*