Comorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease

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

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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 .

Original languageEnglish (US)
Pages (from-to)e011133
JournalJournal of the American Heart Association
Volume8
Issue number4
DOIs
StatePublished - Feb 19 2019

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Post-Traumatic Stress Disorders
Cardiovascular Diseases
Veterans Health
Dyssomnias
Smoking
Electronic Health Records
Anxiety Disorders
Proportional Hazards Models
Substance-Related Disorders
Psychiatry
Comorbidity
Depression

Keywords

  • cardiovascular disease
  • epidemiology
  • posttraumatic stress disorder
  • veterans

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease. / 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.; van den Berk-Clark, Carissa; Lustman, Patrick J.

In: Journal of the American Heart Association, Vol. 8, No. 4, 19.02.2019, p. e011133.

Research output: Contribution to journalArticle

Scherrer, JF, Salas, J, Cohen, BE, Schnurr, PP, Schneider, FD, Chard, KM, Tuerk, P, Friedman, MJ, Norman, SB, van den Berk-Clark, C & Lustman, PJ 2019, 'Comorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease', Journal of the American Heart Association, vol. 8, no. 4, pp. e011133. https://doi.org/10.1161/JAHA.118.011133
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. ; van den Berk-Clark, Carissa ; Lustman, Patrick J. / Comorbid Conditions Explain the Association Between Posttraumatic Stress Disorder and Incident Cardiovascular Disease. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 4. pp. e011133.
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abstract = "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 .",
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AU - Salas, Joanne

AU - Cohen, Beth E.

AU - Schnurr, Paula P.

AU - Schneider, F. David

AU - Chard, Kathleen M.

AU - Tuerk, Peter

AU - Friedman, Matthew J.

AU - Norman, Sonya B.

AU - van den Berk-Clark, Carissa

AU - Lustman, Patrick J.

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N2 - 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 .

AB - 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 .

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KW - epidemiology

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