title: Post-traumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women.
abstract: BACKGROUND
  Prior studies suggest that post-traumatic stress disorder (PTSD) is associated with elevated cardiovascular disease (CVD) risk, but effects of duration and remission of PTSD symptoms have rarely been evaluated.
  
  
  METHODS
  We examined the association of time-updated PTSD symptom severity, remission and duration with incident CVD risk (552 confirmed myocardial infarctions or strokes) over 20 years in 49 859 women in the Nurses' Health Study II. Among women who reported trauma on the Brief Trauma Questionnaire, PTSD symptoms, assessed by a screener, were classified by symptom severity and chronicity: (a) no symptoms, (b) 1-3 ongoing, (c) 4-5 ongoing, (d) 6-7 ongoing, (e) 1-3 remitted, (f) 4-7 remitted symptoms. Inverse probability weighting was used to estimate marginal structural logistic regression models, adjusting for time-varying and time-invariant confounders.
  
  
  RESULTS
  Compared with women with no trauma exposure, women with trauma/no PTSD [odds ratio (OR) 1.30, 95% confidence interval (CI) 1.03-1.65] and women with trauma/6-7 symptoms (OR 1.69, 95% CI 1.08-2.63) had elevated risk of CVD; women with remitted symptoms did not have elevated CVD risk. Among women exposed to trauma, every 5 additional years of PTSD symptomology was associated with 9% higher CVD incidence compared with women with trauma/no PTSD.
  
  
  CONCLUSIONS
  The findings suggest that alleviating PTSD symptoms shortly after onset may attenuate CVD risk.
authors.affiliation: Department of Social and Behavioral Sciences,Harvard T.H. Chan School of Public Health,Boston, MA,USA.
authors.forename: P
authors.initials: P
authors.lastname: Gilsanz
authors.affiliation: Department of Social and Behavioral Sciences,Harvard T.H. Chan School of Public Health,Boston, MA,USA.
authors.forename: A
authors.initials: A
authors.lastname: Winning
authors.affiliation: Department of Epidemiology,Harvard T.H. Chan School of Public Health,Boston,MA,USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Koenen
authors.affiliation: Department of Social and Behavioral Sciences,Harvard T.H. Chan School of Public Health,Boston, MA,USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Roberts
authors.affiliation: Department of Epidemiology,Harvard T.H. Chan School of Public Health,Boston,MA,USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Sumner
authors.affiliation: Department of Biostatistics,Mailman School of Public Health, Columbia University,New York,NY,USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Epidemiology and Biostatistics,University of California San Francisco School of Medicine,San Francisco, CA,USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Glymour
authors.affiliation: Department of Epidemiology,Harvard T.H. Chan School of Public Health,Boston,MA,USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Department of Social and Behavioral Sciences,Harvard T.H. Chan School of Public Health,Boston, MA,USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Kubzansky
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012075:Remission, Spontaneous; D012306:Risk; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000503:physiopathology*; D020521:Stroke / Q000453:epidemiology*; D013997:Time Factors
keywords: Duration; marginal structural models; post-traumatic stress disorder; remission; severity