Posttraumatic stress disorder may increase the risk of coronary heart disease in older men

A higher level of symptoms of posttraumatic stress disorder may increase the risk of coronary heart disease in older men, according to a report in the January issue of the Archives of General Psychiatry.

A link between stress and coronary heart disease (CHD) has long been proposed. Numerous studies have found that cardiovascular disease and its risk factors are more common among individuals with posttraumatic stress disorder (PTSD), according to background information in the article. But to the authors' knowledge, no prospective studies to date have examined PTSD in relation to CHD risk.

Laura D. Kubzansky, Ph.D., of the Harvard School of Public Health, Boston, and colleagues conducted a prospective study to test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using two different measures of PTSD (the Mississippi Scale for Combat-Related PTSD and the Keane PTSD scale). The authors analyzed data on 1,946 men enrolled in the Veterans Affairs Normative Aging Study. All the study subjects were community-dwelling men from the Greater Boston area who served in the military. The authors looked for incident (new cases) of coronary heart disease occurring during follow-up through May 2001.

Using the Mississippi Scale for Combat-Related PTSD, the authors found that for each increase in symptom level, the men had a 26 percent increased risk for non-fatal heart attack and fatal CHD combined. They had a 21 percent increased risk for all CHD outcomes combined (non-fatal heart attack, fatal CHD, and angina). The findings were replicated using the Keane PTSD scale.

"This pattern of effects suggests that individuals with higher levels of PTSD symptoms are not simply prone to reporting higher levels of chest pain or other physical symptoms but may well be at higher risk for developing CHD," the authors write.

"These data suggest that prolonged stress and significant levels of PTSD symptoms may increase the risk for CHD in older male veterans," they conclude. "These results are provocative and suggest that exposure to trauma and prolonged stress not only may increase the risk for serious mental health problems but are also cardiotoxic."