Post-Traumatic Stress Disorder and Incidence of Coronary Heart Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:62

Article

Vaccarino, Viola^1,2  Goldberg, Jack^3,4  Rooks, Cherie¹  Shah, Amit J.²  Veledar, Emir²  Faber, Tracy L.⁵  Votaw, John R.⁵  Forsberg, Christopher W.^3,4  Bremner, J. Douglas⁶ 

[1] Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA

[2] Emory Univ, Sch Med, Dept Med, Div Cardiol, Atlanta, GA 30322 USA

[3] Univ Washington, Vietnam Era Twin Registry, Seattle VA Epidemiol Res & Informat Ctr, Seattle, WA 98195 USA

[4] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA

[5] Emory Univ, Sch Med, Dept Radiol, Atlanta, GA 30322 USA

[6] Emory Univ, Sch Med, Dept Psychiat & Behav Sci, Atlanta, GA 30322 USA

关键词: cardiovascular diseases;    epidemiology;    risk factors;    stress;   

DOI  :  10.1016/j.jacc.2013.04.085

来源: Elsevier

【 摘 要 】

Objectives The aim of this study was to determine whether post-traumatic stress disorder (PTSD) is associated with coronary heart disease (CHD) using a prospective twin study design and objective measures of CHD. Background It has long been hypothesized that PTSD increases the risk of CHD, but empirical evidence using objective measures is limited. Methods We conducted a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Among twin pairs without self-reported CHD at baseline, we selected pairs discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition. All underwent a clinic visit after a median follow-up of 13 years. Outcomes included clinical events (myocardial infarction, other hospitalizations for CHD and coronary revascularization) and quantitative measures of myocardial perfusion by [N-13] ammonia positron emission tomography, including a stress total severity score and coronary flow reserve. Results A total of 562 twins (281 pairs) with a mean age of 42.6 years at baseline were included in this study. The incidence of CHD was more than double in twins with PTSD (22.6%) than in those without PTSD (8.9%; p < 0.001). The association remained robust after adjusting for lifestyle factors, other risk factors for CHD, and major depression (odds ratio: 2.2; 95% confidence interval: 1.2 to 4.1). Stress total severity score was significantly higher (+95%, p = 0.001) and coronary flow reserve was lower (-0.21, p = 0.02) in twins with PTSD than in those without PTSD, denoting worse myocardial perfusion. Associations were only mildly attenuated in 117 twin pairs discordant for PTSD. Conclusions Among Vietnam-era veterans, PTSD is a risk factor for CHD. (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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