title: Terrorism, acute stress, and cardiovascular health: a 3-year national study following the September 11th attacks.
abstract: BACKGROUND
  The terrorist attacks of 9/11 (September 11, 2001) present an unusual opportunity to examine prospectively the physical health impact of extreme stress in a national sample.
  
  
  OBJECTIVE
  To examine the degree to which acute stress reactions to the 9/11 terrorist attacks predict cardiovascular outcomes in a national probability sample over the subsequent 3 years.
  
  
  METHODS
  A national probability sample of 2729 adults (78.1% participation rate), 95.0% of whom had completed a health survey before 9/11 (final health sample, 2592), completed a Web-based assessment of acute stress responses approximately 9 to 14 days after the terrorist attacks. Follow-up health surveys reassessed physician-diagnosed cardiovascular ailments 1 (n = 1923, 84.3% participation rate), 2 (n = 1576, 74.2% participation rate), and 3 (n = 1950, 78.9% participation rate) years following the attacks.
  
  
  METHODS
  Reports of physician-diagnosed cardiovascular ailments over the 3 years following the attacks.
  
  
  RESULTS
  Acute stress responses to the 9/11 attacks were associated with a 53% increased incidence of cardiovascular ailments over the 3 subsequent years, even after adjusting for pre-9/11 cardiovascular and mental health status, degree of exposure to the attacks, cardiovascular risk factors (ie, smoking, body mass index, and number of endocrine ailments), total number of physical health ailments, somatization, and demographics. Individuals reporting high levels of acute stress immediately following the attacks reported an increased incidence of physician-diagnosed hypertension (rate ratios, 2.15 at 1 year and 1.75 at 2 years) and heart problems (rate ratios, 2.98 at 1 year and 3.12 at 2 years) over 2 years. Among individuals reporting ongoing worry about terrorism post-9/11, high 9/11-related acute stress symptoms predicted increased risk of physician-diagnosed heart problems 2 to 3 years following the attacks (rate ratios, 4.67 at 2 years and 3.22 at 3 years).
  
  
  CONCLUSIONS
  Using health data collected before 9/11 as a baseline, acute stress response to the terrorist attacks predicted increased reports of physician-diagnosed cardiovascular ailments over 3 years following the attacks.
authors.affiliation: Program in Nursing Science, College of Health Sciences, 205B Irvine Hall, University of California, Irvine, CA 92697-3959, USA. aholman@uci.edu
authors.forename: E Alison
authors.initials: EA
authors.lastname: Holman
authors.forename: Roxane Cohen
authors.initials: RC
authors.lastname: Silver
authors.forename: Michael
authors.initials: M
authors.lastname: Poulin
authors.forename: Judith
authors.initials: J
authors.lastname: Andersen
authors.forename: Virginia
authors.initials: V
authors.lastname: Gil-Rivas
authors.forename: Daniel N
authors.initials: DN
authors.lastname: McIntosh
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013315:Stress, Psychological; D023481:Terrorism / Q000523:psychology*; D014481:United States / Q000453:epidemiology