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Young adults with PTSD at elevated risk for stroke by middle age
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Young adults who develop PTSD have a greater risk for transient ischemic attack and ischemic stroke, independent of established risk factors, coexisting psychiatric disorders and health care utilization, according to findings published in Stroke.
In a cohort of young and middle-aged veterans with no prior history of cerebrovascular events, PTSD was significantly associated with new-onset TIA (HR = 2.02; 95% CI, 1.62-2.52) as well as ischemic stroke (HR = 1.62; 95% CI, 1.47-1.79), according to the researchers.
Moreover, using fully adjusted survival models, men with PTSD were found to be at greater risk for stroke than women (HR = 0.63; 95% CI, 0.47-0.86). However, adjustment for sex did not moderate the association between PTSD and TIA.
“Stroke has a devastating impact on young patients and their families, many of whom struggle to cope with long-term disability, depression and economic loss during their most productive years,” Lindsey Rosman, PhD, assistant professor of medicine in the division of cardiology at the University of North Carolina School of Medicine, Chapel Hill, said in a press release. “Ten [percent] to 14% of ischemic strokes occur in adults ages 18 to 45, and we don’t really have a good understanding of the risk factors for stroke in this age group.”
In other findings, when controlled for health care utilization, researchers found that PTSD remained strongly associated with incident TIA (HR = 1.59; 95% CI, 1.26-2.02) and stroke (HR = 1.34; 95% CI, 1.2-1.5). According to the study, these findings suggested that increased medical attention due to PTSD had only modest effect on the association between PTSD and TIA or stroke.
Additionally, in fully adjusted models, which included established risk factors and psychiatric comorbidities, researchers observed that the relationship between PTSD and incident TIA remained significant (HR = 1.61; 95% CI, 1.27-2.04).
“Clinicians should be aware that mental health conditions such as PTSD are increasingly prevalent among young people and may have major implications for their risk of stroke,” Rosman said in the release. “Our findings raise important questions about whether early recognition and successful treatment of PTSD can prevent or decrease the likelihood of developing stroke in those exposed to violence, trauma and severe adversity.”
In this prospective study, researchers analyzed medical data from 987,855 veterans who first accessed care through the Veterans Health Administration from October 2001 to November 2014 (mean age, 30 years; 88% men; 64% white; 29% with PTSD) and had experienced neither TIA nor ischemic stroke at baseline. Adjusting for sex and conducting sensitivity analyses that controlled for health care utilization, researchers aimed to study the relationship between PTSD and TIA or ischemic stroke.
“We need to improve stroke prevention in young adults by developing targeted screening programs and age-appropriate interventions,” Rosman said in the release. “Addressing mental health issues including PTSD may be an important part of a broader public health initiative to reduce the growing burden of stroke in young people.” – by Scott Buzby
Disclosure: Rosman reports no relevant financial disclosures.
Perspective
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Larry B. Goldstein, MD, FAAN, FANA, FAHA
The study finds an association between PTSD and incident stroke or TIA in a relatively young cohort of combat veterans. Although studies of this type cannot establish causality, it does suggest that patients with PTSD should be aggressively assessed for modifiable stroke risk factors.
The study is rigorously designed, but as the authors appropriately note, is subject to the limitations of this methodology. A statistical assessment of unmeasured confounding would be helpful. In addition, although the patients were followed in the VA system, they may also have received treatments outside of the VA.
Replication in another cohort would support the association found in this group of military veterans. A prospective study evaluating the impact of aggressive risk factor modification compared to usual care would provide more definitive evidence of the impact of altering care in this population.
The work is consistent with other studies finding an association between psychological stress and stroke risk.
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