title: Lifetime trauma exposure and prospective cardiovascular events and all-cause mortality: findings from the Heart and Soul Study.
abstract: OBJECTIVE
  Little is known about the effect of cumulative psychological trauma on health outcomes in patients with cardiovascular disease. The objective of this study was to prospectively examine the association between lifetime trauma exposure and recurrent cardiovascular events or all-cause mortality in patients with existing cardiovascular disease.
  
  
  METHODS
  A total of 1021 men and women with cardiovascular disease were recruited in 2000 to 2002 and followed annually. Trauma history and psychiatric comorbidities were assessed at baseline using the Computerized Diagnostic Interview Schedule for DSM-IV. Health behaviors were assessed using standardized questionnaires. Outcome data were collected annually, and all medical records were reviewed by two independent, blinded physician adjudicators. We used Cox proportional hazards models to evaluate the association between lifetime trauma exposure and the composite outcome of cardiovascular events and all-cause mortality.
  
  
  RESULTS
  During an average of 7.5 years of follow-up, there were 503 cardiovascular events and deaths. Compared with the 251 participants in the lowest trauma exposure quartile, the 256 participants in the highest exposure quartile had a 38% greater risk of adverse outcomes (hazard ratio = 1.38, 95% confidence interval = 1.06-1.81), adjusted for age, sex, race, income, education, depression, posttraumatic stress disorder, generalized anxiety disorder, smoking, physical inactivity, and illicit drug abuse.
  
  
  CONCLUSIONS
  Cumulative exposure to psychological trauma was associated with an increased risk of recurrent cardiovascular events and mortality, independent of psychiatric comorbidities and health behaviors. These data add to a growing literature showing enduring effects of repeated trauma exposure on health that are independent of trauma-related psychiatric disorders such as depression and posttraumatic stress disorder.
authors.affiliation: Department of Veterans Affairs Medical Center, General Internal Medicine (111A1), 4150 Clement Street, San Francisco, CA 94121. Beth.Cohen@ucsf.edu.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Hendrickson
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.forename: Beeya
authors.initials: B
authors.lastname: Na
authors.forename: Mathilda
authors.initials: M
authors.lastname: Regan
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D007406:Interview, Psychological; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D013315:Stress, Psychological / Q000401:mortality*; D014481:United States / Q000453:epidemiology
keywords: cardiovascular disease; cardiovascular mortality; depression; myocardial infarction; posttraumatic stress disorder; psychological trauma