title: Risk of stroke among patients with post-traumatic stress disorder: nationwide longitudinal study.
abstract: BACKGROUND
  Previous evidence has shown positive associations between post-traumatic stress disorder (PTSD) and hypertension, dyslipidaemia and diabetes mellitus, which are all risk factors for stroke, but the role of PTSD in the subsequent development of stroke is still unknown.
  
  
  OBJECTIVE
  To investigate the temporal association between PTSD and the development of stroke.
  
  
  METHODS
  Identified from the Taiwan National Health Insurance Research Database, 5217 individuals aged ≥18 years, with PTSD but with no history of stroke, and 20 868 age- and gender-matched controls were enrolled between 2002 and 2009, and followed up until the end of 2011 to identify the development of stroke.
  
  
  RESULTS
  Individuals with PTSD had an increased risk of developing any stroke (hazard ratio (HR) 3.37, 95% CI 2.44-4.67) and ischaemic stroke (HR = 3.47, 95% CI 2.23-5.39) after adjusting for demographic data and medical comorbidities. Sensitivity tests showed consistent findings (any stroke HR = 3.02, 95% CI 2.13-4.28; ischaemic stroke HR = 2.89, 95% CI 1.79-4.66) after excluding the first year of observation.
  
  
  CONCLUSIONS
  Individuals with PTSD have an increased risk of developing any stroke and ischaemic stroke. Further studies are required to investigate the underlying mechanisms.
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Mu-Hong
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tai-Long
authors.initials: TL
authors.lastname: Pan
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Li
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lin
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ying-Sheue
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ying-Chiao
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Tsai
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ju-Wei
authors.initials: JW
authors.lastname: Hsu
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kai-Lin
authors.initials: KL
authors.lastname: Huang
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chia-Fen
authors.initials: CF
authors.lastname: Tsai
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wen-Han
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
authors.affiliation: Mu-Hong Chen, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Tai-Long Pan, PhD, School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, and Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan; Cheng-Ta Li, MD, PhD, Wei-Chen Lin, MD, Ying-Sheue Chen, MD, Ying-Chiao Lee, MD, Shih-Jen Tsai, MD, Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Chia-Fen Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei; Wen-Han Chang, MSc, Department of Psychiatry, Taipei Veterans General Hospital, Taipei; Tzeng-Ji Chen, MD, PhD, Department of Family Medicine, Taipei Veterans General Hospital, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; Tung-Ping Su, MD, Ya-Mei Bai, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ya-Mei
authors.initials: YM
authors.lastname: Bai
mesh_terms: D000328:Adult; D017677:Age Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology