title: Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review.
abstract: OBJECTIVE
  The aim of this study was to estimate the association of posttraumatic stress disorder (PTSD) with risk for incident coronary heart disease (CHD).
  
  
  METHODS
  A systematic review and meta-analysis were used as study designs.
  
  
  METHODS
  Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and PubMed Related Articles and through a manual search of reference lists (1948-present).
  
  
  METHODS
  All studies that assessed PTSD in participants initially free of CHD and subsequently assessed CHD/cardiac-specific mortality were included.
  
  
  METHODS
  Two investigators independently extracted estimates of the association of PTSD with CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HRs), and a random-effects model was used to pool results. A secondary analysis including only studies that reported estimates adjusted for depression was conducted.
  
  
  RESULTS
  Six studies met our inclusion criteria (N = 402,274); 5 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.55 (95% CI 1.34-1.79) before adjustment for depression. The pooled HR estimate for the 5 depression-adjusted estimates (N = 362,950) was 1.27 (95% CI 1.08-1.49).
  
  
  CONCLUSIONS
  Posttraumatic stress disorder is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. It is common in both military veterans and civilian trauma survivors, and these results suggest that it may be a modifiable risk factor for CHD. Future research should identify the mechanisms of this association and determine whether PTSD treatment offsets CHD risk.
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY. Electronic address: dee2109@columbia.edu.
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
mesh_terms: D003327:Coronary Disease / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*