Combined effect of posttraumatic stress disorder and prescription opioid use on risk of cardiovascular disease

Jeffrey F. Scherrer, Joanne Salas, Patrick Lustman, Peter Tuerk, Sarah Gebauer, Sonya B. Norman, F. David Schneider, Kathleen M. Chard, Carissa van den Berk-Clark, Beth E. Cohen, Paula P. Schnurr

Research output: Contribution to journalArticle

Abstract

Aim: Prescription opioid analgesic use (OAU) is associated with increased risk of cardiovascular disease (CVD). OAU is more common in patients with than without posttraumatic stress disorder (PTSD), and PTSD is associated with higher CVD risk. We determined whether PTSD and OAU have an additive or multiplicative association with incident CVD. Methods and results: Veterans Health Affairs patient medical record data from 2008 to 2015 was used to identify 2861 patients 30–70 years of age, free of cancer, CVD and OAU for 12 months before index date. We defined a four-level exposure variable: 1) no PTSD/no OAU, 2) OAU alone, 3) PTSD alone and 4) PTSD+OAU. Cox proportional hazard models estimated the association between the exposure variable and incident CVD. The mean age was 49.0 (±11.0), 85.7% were male and 58.3% were White, 34.4% had no PTSD/no OAU, 32.9% had PTSD alone, 10.6% had OAU alone, and 22.1% had PTSD+OAU. Compared with patients with no PTSD/no OAU, those with PTSD alone were not at increased risk of incident CVD (hazard ratio = 0.82; 95% confidence interval (CI): 0.63–1.17); however, OAU alone and PTSD+OAU were both significantly associated with incident CVD (hazard ratio = 1.99; 95% CI:1.36–2.92 and hazard ratio = 2.20; 95% CI: 1.61–3.02). There was no significant additive or multiplicative PTSD and OAU association with incident CVD. Conclusion: OAU is associated with nearly a two-fold increased risk of CVD in patients with and without PTSD. Despite no additive or multiplicative interaction effects, the high prevalence of OAU in PTSD may represent a novel contributor to the elevated CVD burden among patients with PTSD.

Original languageEnglish (US)
JournalEuropean Journal of Preventive Cardiology
DOIs
StatePublished - Jan 1 2019

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Post-Traumatic Stress Disorders
Opioid Analgesics
Prescriptions
Cardiovascular Diseases
Confidence Intervals
Veterans Health
Proportional Hazards Models
Medical Records

Keywords

  • cardiovascular disease
  • cohort
  • epidemiology
  • medical records
  • opioids
  • PTSD

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

Cite this

Combined effect of posttraumatic stress disorder and prescription opioid use on risk of cardiovascular disease. / Scherrer, Jeffrey F.; Salas, Joanne; Lustman, Patrick; Tuerk, Peter; Gebauer, Sarah; Norman, Sonya B.; Schneider, F. David; Chard, Kathleen M.; van den Berk-Clark, Carissa; Cohen, Beth E.; Schnurr, Paula P.

In: European Journal of Preventive Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Scherrer, JF, Salas, J, Lustman, P, Tuerk, P, Gebauer, S, Norman, SB, Schneider, FD, Chard, KM, van den Berk-Clark, C, Cohen, BE & Schnurr, PP 2019, 'Combined effect of posttraumatic stress disorder and prescription opioid use on risk of cardiovascular disease', European Journal of Preventive Cardiology. https://doi.org/10.1177/2047487319850717
Scherrer, Jeffrey F. ; Salas, Joanne ; Lustman, Patrick ; Tuerk, Peter ; Gebauer, Sarah ; Norman, Sonya B. ; Schneider, F. David ; Chard, Kathleen M. ; van den Berk-Clark, Carissa ; Cohen, Beth E. ; Schnurr, Paula P. / Combined effect of posttraumatic stress disorder and prescription opioid use on risk of cardiovascular disease. In: European Journal of Preventive Cardiology. 2019.
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abstract = "Aim: Prescription opioid analgesic use (OAU) is associated with increased risk of cardiovascular disease (CVD). OAU is more common in patients with than without posttraumatic stress disorder (PTSD), and PTSD is associated with higher CVD risk. We determined whether PTSD and OAU have an additive or multiplicative association with incident CVD. Methods and results: Veterans Health Affairs patient medical record data from 2008 to 2015 was used to identify 2861 patients 30–70 years of age, free of cancer, CVD and OAU for 12 months before index date. We defined a four-level exposure variable: 1) no PTSD/no OAU, 2) OAU alone, 3) PTSD alone and 4) PTSD+OAU. Cox proportional hazard models estimated the association between the exposure variable and incident CVD. The mean age was 49.0 (±11.0), 85.7{\%} were male and 58.3{\%} were White, 34.4{\%} had no PTSD/no OAU, 32.9{\%} had PTSD alone, 10.6{\%} had OAU alone, and 22.1{\%} had PTSD+OAU. Compared with patients with no PTSD/no OAU, those with PTSD alone were not at increased risk of incident CVD (hazard ratio = 0.82; 95{\%} confidence interval (CI): 0.63–1.17); however, OAU alone and PTSD+OAU were both significantly associated with incident CVD (hazard ratio = 1.99; 95{\%} CI:1.36–2.92 and hazard ratio = 2.20; 95{\%} CI: 1.61–3.02). There was no significant additive or multiplicative PTSD and OAU association with incident CVD. Conclusion: OAU is associated with nearly a two-fold increased risk of CVD in patients with and without PTSD. Despite no additive or multiplicative interaction effects, the high prevalence of OAU in PTSD may represent a novel contributor to the elevated CVD burden among patients with PTSD.",
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author = "Scherrer, {Jeffrey F.} and Joanne Salas and Patrick Lustman and Peter Tuerk and Sarah Gebauer and Norman, {Sonya B.} and Schneider, {F. David} and Chard, {Kathleen M.} and {van den Berk-Clark}, Carissa and Cohen, {Beth E.} and Schnurr, {Paula P.}",
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AU - Scherrer, Jeffrey F.

AU - Salas, Joanne

AU - Lustman, Patrick

AU - Tuerk, Peter

AU - Gebauer, Sarah

AU - Norman, Sonya B.

AU - Schneider, F. David

AU - Chard, Kathleen M.

AU - van den Berk-Clark, Carissa

AU - Cohen, Beth E.

AU - Schnurr, Paula P.

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N2 - Aim: Prescription opioid analgesic use (OAU) is associated with increased risk of cardiovascular disease (CVD). OAU is more common in patients with than without posttraumatic stress disorder (PTSD), and PTSD is associated with higher CVD risk. We determined whether PTSD and OAU have an additive or multiplicative association with incident CVD. Methods and results: Veterans Health Affairs patient medical record data from 2008 to 2015 was used to identify 2861 patients 30–70 years of age, free of cancer, CVD and OAU for 12 months before index date. We defined a four-level exposure variable: 1) no PTSD/no OAU, 2) OAU alone, 3) PTSD alone and 4) PTSD+OAU. Cox proportional hazard models estimated the association between the exposure variable and incident CVD. The mean age was 49.0 (±11.0), 85.7% were male and 58.3% were White, 34.4% had no PTSD/no OAU, 32.9% had PTSD alone, 10.6% had OAU alone, and 22.1% had PTSD+OAU. Compared with patients with no PTSD/no OAU, those with PTSD alone were not at increased risk of incident CVD (hazard ratio = 0.82; 95% confidence interval (CI): 0.63–1.17); however, OAU alone and PTSD+OAU were both significantly associated with incident CVD (hazard ratio = 1.99; 95% CI:1.36–2.92 and hazard ratio = 2.20; 95% CI: 1.61–3.02). There was no significant additive or multiplicative PTSD and OAU association with incident CVD. Conclusion: OAU is associated with nearly a two-fold increased risk of CVD in patients with and without PTSD. Despite no additive or multiplicative interaction effects, the high prevalence of OAU in PTSD may represent a novel contributor to the elevated CVD burden among patients with PTSD.

AB - Aim: Prescription opioid analgesic use (OAU) is associated with increased risk of cardiovascular disease (CVD). OAU is more common in patients with than without posttraumatic stress disorder (PTSD), and PTSD is associated with higher CVD risk. We determined whether PTSD and OAU have an additive or multiplicative association with incident CVD. Methods and results: Veterans Health Affairs patient medical record data from 2008 to 2015 was used to identify 2861 patients 30–70 years of age, free of cancer, CVD and OAU for 12 months before index date. We defined a four-level exposure variable: 1) no PTSD/no OAU, 2) OAU alone, 3) PTSD alone and 4) PTSD+OAU. Cox proportional hazard models estimated the association between the exposure variable and incident CVD. The mean age was 49.0 (±11.0), 85.7% were male and 58.3% were White, 34.4% had no PTSD/no OAU, 32.9% had PTSD alone, 10.6% had OAU alone, and 22.1% had PTSD+OAU. Compared with patients with no PTSD/no OAU, those with PTSD alone were not at increased risk of incident CVD (hazard ratio = 0.82; 95% confidence interval (CI): 0.63–1.17); however, OAU alone and PTSD+OAU were both significantly associated with incident CVD (hazard ratio = 1.99; 95% CI:1.36–2.92 and hazard ratio = 2.20; 95% CI: 1.61–3.02). There was no significant additive or multiplicative PTSD and OAU association with incident CVD. Conclusion: OAU is associated with nearly a two-fold increased risk of CVD in patients with and without PTSD. Despite no additive or multiplicative interaction effects, the high prevalence of OAU in PTSD may represent a novel contributor to the elevated CVD burden among patients with PTSD.

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