Open AccessComorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease
Author(s) -
Scherrer Jeffrey F.,
Salas Joanne,
Cohen Beth E.,
Schnurr Paula P.,
Schneider F. David,
Chard Kathleen M.,
Tuerk Peter,
Friedman Matthew J.,
Norman Sonya B.,
BerkClark Carissa,
Lustman Patrick J.
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.118.011133
Subject(s) - medicine , hazard ratio , veterans affairs , anxiety , psychiatry , proportional hazards model , depression (economics) , population , anxiety disorder , comorbidity , cohort , confidence interval , environmental health , economics , macroeconomics
Background Posttraumatic stress disorder ( PTSD ) is associated with risk of cardiovascular disease ( CVD ). Biopsychosocial factors associated with PTSD likely account for some or all of this association. We determined whether 1, or a combination of comorbid conditions explained the association between PTSD and incident CVD . Methods and Results Eligible patients used 1 of 5 Veterans Health Affairs medical centers distributed across the United States. Data were obtained from electronic health records. At index date, 2519 Veterans Health Affairs ( VA ) patients, 30 to 70 years of age, had PTSD diagnoses and 1659 did not. Patients had no CVD diagnoses for 12 months before index date. Patients could enter the cohort between 2008 and 2012 with follow‐up until 2015. Age‐adjusted Cox proportional hazard models were computed before and after adjusting for comorbidities. Patients were middle aged (mean=50.1 years, SD ±11.0), mostly male (87.0%), and 60% were white. The age‐adjusted association between PTSD and incident CVD was significant (hazard ratio=1.41; 95% CI : 1.21–1.63). After adjustment for metabolic conditions, the association between PTSD and incident CVD was attenuated but remained significant (hazard ratio=1.23; 95% CI : 1.06–1.44). After additional adjustment for smoking, sleep disorder, substance use disorder, anxiety disorders, and depression, PTSD was not associated with incident CVD (hazard ratio=0.96; 95% CI : 0.81–1.15). Conclusions PTSD is not an independent risk factor for CVD . Physical and psychiatric conditions and smoking that co‐occur with PTSD explain why this patient population has an increased risk of CVD . Careful monitoring may limit exposure to CVD risk factors and subsequent incident CVD .