title: Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women.
abstract: BACKGROUND
  Psychological stress is a proposed risk factor for cardiovascular disease (CVD), and posttraumatic stress disorder (PTSD), the sentinel stress-related mental disorder, occurs twice as frequently in women as men. However, whether PTSD contributes to CVD risk in women is not established.
  
  
  RESULTS
  We examined trauma exposure and PTSD symptoms in relation to incident CVD over a 20-year period in 49 978 women in the Nurses' Health Study II. Proportional hazards models estimated hazard ratios and 95% confidence intervals for CVD events confirmed by additional information or medical record review (n=548, including myocardial infarction [n=277] and stroke [n=271]). Trauma exposure and PTSD symptoms were assessed by using the Brief Trauma Questionnaire and a PTSD screen. In comparison with no trauma exposure, endorsing ≥4 PTSD symptoms was associated with increased CVD risk after adjusting for age, family history, and childhood factors (hazard ratio,1.60; 95% confidence interval, 1.20-2.13). Being trauma-exposed and endorsing no PTSD symptoms was associated with elevated CVD risk (hazard ratio, 1.45; 95% confidence interval, 1.15-1.83), although being trauma-exposed and endorsing 1 to 3 PTSD symptoms was not. After adjusting for adult health behaviors and medical risk factors, this pattern of findings was maintained. Health behaviors and medical risk factors accounted for 14% of the trauma/no symptoms-CVD association and 47% of the trauma/4+ symptoms-CVD association.
  
  
  CONCLUSIONS
  Trauma exposure and elevated PTSD symptoms may increase the risk of CVD in this population of women. These findings suggest that screening for CVD risk and reducing health risk behaviors in trauma-exposed women may be promising avenues for prevention and intervention.
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.). js4456@columbia.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sumner
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Roberts
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Jessica
authors.initials: J
authors.lastname: Agnew-Blais
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Qixuan
authors.initials: Q
authors.lastname: Chen
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cerdá
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rexrode
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Shakira F
authors.initials: SF
authors.lastname: Suglia
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: From Department of Epidemiology, Columbia University Mailman School of Public Health, New York (J.A.S., M.S.V.E., M.C., S.F.S., K.C.K.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K., A.L.R., J.A.-B., K.C.K.); Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.S.V.E.); Department of Biostatistics, Columbia University Mailman School of Public Health, New York (Q.C.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.M.R.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.W.R.-E., D.S., E.B.R., K.C.K.); The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.W.R.-E.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.S.); Department of Nutrition, Harvard School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009726:Nurses; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D013315:Stress, Psychological / Q000150:complications; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000150:complications*
keywords: cardiovascular diseases; epidemiology; stress disorders, post-traumatic; women