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PTSD linked to myocardial ischemia
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Patients with posttraumatic stress disorder were more likely to have myocardial ischemia on exercise treadmill testing than those without the disorder in a recent prospective cohort study.
In the Mind Your Heart Study, researchers evaluated data collected from 663 participants treated on an outpatient basis at two Veterans Affairs Medical Centers in California between 2008 and 2010. Incidence of myocardial ischemia was compared between patients with and without symptoms of posttraumatic stress disorder (PTSD) as indicated by the Clinician-Administered PTSD Scale. Evidence of ischemia was determined via exercise treadmill testing.
PTSD was observed in 35% of the cohort, including 210 patients with full PTSD and 20 with partial PTSD. Myocardial ischemia on testing was observed in 17% of patients with PTSD compared with 10% of those without (P=.006).
A significant association between ischemia and PTSD remained after adjustment for factors that included age, sex, history of CVD, obesity, sleep quality, depression and the presence of traditional cardiac risk factors (adjusted OR=2.42; 95% CI, 1.39-4.22). Exclusion of patients with prior CVD did not eliminate the significance of this association (OR=2.24; 95% CI, 1.2-4.18). The use of continuous PTSD symptom score as the predictor of ischemia also yielded a significant association with myocardial ischemia (OR=1.12; 95% CI, 1.03-1.22 per 10-point score change).
Sensitivity analysis adjusting for peak exercise capacity during testing did not significantly alter results, nor did exclusion of patients with partial PTSD from analysis or the addition of those with partial PTSD to the non-PTSD group.
“While research continues on causal mechanisms, providers still have opportunities to intervene and prevent potentially disabling or fatal CVD events in patients with PTSD,” the researchers wrote. “… Discussing how PTSD can have a harmful impact on physical health may provide additional encouragement for patients to seek treatment. Our finding that PTSD symptom severity was linked to CVD risk also suggests that improving symptoms could lower cardiac risk, though it would be important to examine this in PTSD treatment trials.”
Disclosure: One researcher reports receiving study medication from Actelion for a study funded by the Department of Defense and from GlaxoSmithKline for a study funded by the Department of Veterans Affairs.
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