PTSD Increases Chance of Heart Failure

Researchers explain the "substantial" evidence linking posttraumatic stress disorder with coronary artery disease.


Veterans with posttraumatic stress disorder (PTSD) are nearly 50% more likely to develop heart failure (HF), compared with veterans without PTSD, say researchers from Ohio State University in Columbus and the National Center for PTSD, Pacific Islands Division and VA Pacific Islands Health Care System, both in Honolulu, Hawaii. They reviewed medical records for 8,248 veterans from VA Pacific Islands between 2005 and 2012. According to the researchers, theirs is the first large-scale longitudinal study to report an association between PTSD and incident HF in an outpatient sample of U.S. veterans.

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During the course of the study, 1,712 veterans were diagnosed with PTSD. Over an average follow-up of 7.2 years, 287 veterans without PTSD and 84 veterans with PTSD developed HF. The difference between the 2 groups held even after the researchers controlled for known clinical risk factors and military-specific factors, such as combat service.

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The evidence linking PTSD with coronary artery disease is substantial, the researchers say. They note that veterans with PTSD are considerably more likely to have abnormal electrocardiograph results, myocardial infarctions, and atrioventricular conduction deficits, compared with veterans without PTSD. They cite several hypotheses for the mechanisms by which PTSD contributes to heart disease. One is that a hallmark symptom of PTSD, hyperarousal, and the subsequent sustained sympathetic nervous system activation affect the release of neurotransmitters and endocrine function. Those changes, they point out, have negative effects on the cardiovascular system.

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Given the high prevalence of PTSD in veterans and the increasing incidence of HF in general, the researchers advise, outpatient care must include both mental health and chronic disease management.

Roy SS, Foraker RE, Girton RA, Mansfield AJ. Am J Public Health. 2015;105(4):757-763.
doi: 10.2105/AJPH.2014.302342.

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