title: Associations of Trauma Exposure and Posttraumatic Stress Symptoms With Venous Thromboembolism Over 22 Years in Women.
abstract: Trauma exposure and posttraumatic stress disorder (PTSD) have been linked to myocardial infarction and stroke in women, with biological and behavioral mechanisms implicated in underlying risk. The third most common cardiovascular illness, venous thromboembolism (VTE), is a specific health risk for women. Given previous associations with other cardiovascular diseases, we hypothesized that high levels of trauma and PTSD symptoms would be associated with higher risk of incident VTE in younger and middle-aged women.
  
  
  
  We used proportional hazards models to estimate hazard ratios (HRs) and 95% CIs for new-onset VTE (960 events) over 22 years in 49 296 women in the Nurses' Health Study II. Compared to no trauma exposure, both trauma exposure and PTSD symptoms were significantly associated with increased risk of developing VTE, adjusting for demographics, family history, and childhood adiposity. Women with the most PTSD symptoms exhibited the greatest risk elevation: trauma/6 to 7 symptoms: HR=2.42 (95% CI, 1.83-3.20); trauma/4 to 5 symptoms: HR=2.00 (95% CI, 1.55-2.59); trauma/1 to 3 symptoms: HR=1.44 (95% CI, 1.12-1.84); trauma/no symptoms: HR=1.72 (95% CI, 1.43-2.08). Results were similar, although attenuated, when adjusting for VTE-relevant medications, medical conditions, and health behaviors.
  
  
  
  Women with the highest PTSD symptom levels had nearly a 2-fold increased risk of VTE compared to women without trauma exposure in fully adjusted models. Trauma exposure alone was also associated with elevated VTE risk. Trauma and PTSD symptoms may be associated with a hypercoagulable state. Treatment providers should be aware that women with trauma exposure and PTSD symptoms may be vulnerable to VTE.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA js4456@cumc.columbia.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sumner
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kabrhel
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Roberts
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY.
authors.forename: Qixuan
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Winning
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Paola
authors.initials: P
authors.lastname: Gilsanz
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Glymour
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA Psychiatric and Neurodevelopmental Genetics Unit and Department of Psychiatry, Massachusetts General Hospital, Boston, MA Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA.
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016016:Proportional Hazards Models; D000067073:Psychological Trauma / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000453:epidemiology*
keywords: deep vein thrombosis; posttraumatic stress disorder; pulmonary embolism; trauma; venous thromboembolism