In the general population, 10-12% of women and 5-6% of men are likely to develop post-traumatic stress disorder (PTSD), a psychiatric condition characterized by a persistent maladaptive reaction to the exposure to severe psychological stress. For military personnel exposed to combat, the prevalence of PTSD is almost doubled. Many physical health problems, particularly CV symptoms, have been associated with the disorder, but few studies have looked at the relationship between PTSD and CHD.

Viola Vaccarino, MD, PhD, from Rollins School of Public Health at Emory University in Atlanta, Georgia, and colleagues recently designed a prospective twin study to clarify this relationship. Using data from the Vietnam Era Twin Registry, the researchers selected twin pairs without self-reported CHD at baseline who were discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition.

A total of 562 twins (281 pairs) were included; all were male and middle-aged (mean age 42.6 years). The twin pairs were followed for a median of 13 years and researchers noted incidence of clinical events (MI, other hospitalizations for CHD, and coronary revascularization) and quantitative measures of myocardial perfusion obtained through PET imaging and stress tests.

At baseline, the incidence of CHD was more than double in twins with PTSD (22.6%) than those without PTSD (8.9%). This association remained true even after adjusting for lifestyle factors, other CHD risk factors, and major depression (See Figure 1). Myocardial perfusion was worse in twins with PTSD than those without: stress test results were significantly higher (+95%; p = 0.001) and coronary flow reserve was significantly lower (–0.21; p = 0.02). This increased risk was not explained by higher rate of established CHD risk factors, or adverse health behaviors (such as smoking and alcohol use), or familial risk factors shared by PTSD and CHD did not explain the increased risk.

Although several mechanisms behind this link have been suggested (including alterations in the central and autonomic nervous system and lifestyle factors), the exact mechanisms underlying the link of PTSD to CHD have yet to be clarified. "Future studies should address mechanisms underlying the increased CV risk in persons with PTSD, as this information will help guide effective prevention and treatment strategies aimed at reducing cardiovascular morbidity and mortality in persons with PTSD," Dr. Vaccarino and colleagues concluded.

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Vaccarino V, Goldberg J, Rooks C, et al. J Am Coll Cardiol. 2013 June 26. [Epub ahead of print]

Keywords: Stress Disorders, Post-Traumatic, Life Style, Depressive Disorder, Major, Middle Aged, Risk Factors, Military Personnel, Autonomic Nervous System, Health Behavior

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