Veterans With PTSD May Be at Higher Risk for Heart
WEDNESDAY, Nov. 17 (HealthDay News) -- Veterans suffering from
post-traumatic stress disorder, or PTSD, appear to be at higher
risk for heart disease.
For the first time, researchers have linked PTSD with severe
atherosclerosis (hardening of the arteries), as measured by levels
of calcium deposits in the arteries.
The condition "is emerging as a significant risk factor," said
Dr. Ramin Ebrahimi, co-principal investigator of a study on the
issue presented Wednesday at the annual meeting of the American
Heart Association in Chicago.
The authors are hoping that these and other, similar findings
will prompt doctors, particularly primary care physicians, to more
carefully screen patients for PTSD and, if needed, follow up
aggressively with screening and treatment.
Post-traumatic stress disorder -- triggered by experiencing an
event that causes intense fear, helplessness or horror -- can
include flashbacks, emotional numbing, overwhelming guilt and
shame, being easily startled, and difficulty maintaining close
"When you go to a doctor, they ask questions about diabetes, high blood pressure and cholesterol," said Ebrahimi, who is a research scientist at the Greater Los Angeles Veterans Administration Center. "The goal would be for PTSD to become part of routine screening [for heart disease risk factors]."
Although PTSD is commonly associated with war veterans, it's now
also widely linked to people who have survived traumatic events,
such as rape, a severe accident or an earthquake, flood or other
The authors reviewed electronic medical records of 286,194
veterans, most of them male with an average age 63, who had been
seen at Veterans Administration medical centers in southern
California and Nevada. Some of the veterans had last been on active
duty as far back as the Korean War.
Researchers also had access to coronary artery calcium CT scan
images for 637 of the patients, which showed that those with PTSD
had more calcium built up in their arteries -- a risk factor for
heart disease -- and more cases of atherosclerosis.
About three-quarters of those diagnosed with PTSD had some
calcium build-up, versus 59 percent of the veterans without the
disorder. As a group, the veterans with PTSD had more severe
disease of their arteries, with an average coronary artery
calcification score of 448, compared to a score of 332 in the
veterans without PTSD -- a significantly higher reading.
This is the first time atherosclerosis has been identified as a
possible reason for elevated heart disease in people with PTSD, the
Veterans with PTSD were also more likely than their counterparts
to die from all causes.
During an average follow-up of almost 10 years, and after
adjusting for age, gender, and common risks for heart disease, the
researchers discovered that veterans diagnosed with PTSD had 2.41
times the rate of death from all causes, compared to veterans
In fact, PTSD was diagnosed in only 10.6 percent of all the
veterans studied, but nearly 30 percent of those who died had PTSD,
the results showed.
Among the veterans with a calcium build-up in their arteries,
those with PTSD had a 48 percent increased risk of death overall
and a 41 percent increased risk of dying from cardiovascular
disease, compared to their peers without the disorder.
The authors suspect that PTSD may lead to more severe
atherosclerosis because of the release of various stress hormones
(epinephrine, norepinephrine, cortisol) associated with the
fight-or-flight response characteristics of the disorder.
"That may be injuring the arterial wall," explained Dr. Naser Ahmadi, the study's co-principal investigator and a research scientist with the Greater Los Angeles Veterans Administration Medical Center.
It should be noted that the study did not prove a
cause-and-effect, however. And since it was presented at a meeting,
the data and conclusions should be viewed as preliminary until
published in a peer-reviewed journal.
Dr. Robert Eckel, past president of the American Heart
Association and professor of medicine at the University of
Colorado, Denver, feels that the specific mechanism is still
unclear: Why exactly is PTSD linked to atherosclerosis?
"There's not a clear mechanism. It could be blood pressure, cholesterol, different diets. Do people with PTSD eat more fast food? Are they less physically active? Are they smokers?" Eckel said.
A next step might be to compare people with PTSD with people who
have other psychiatric conditions such as depression or
schizophrenia, Eckel added.
"This is the tip of the iceberg," he said. "We need more surveillance with radar to see under the tip."
The National Center for PTSD has more on
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