AHA 2010: PTSD Linked to Increased Risk of CVD, Death in Veterans

Post-traumatic stress disorder (PTSD) more than doubles a veteran’s risk of death from any cause and is an independent risk factor for cardiovascular disease, according to research presented at the American Heart Association Scientific Sessions 2010.

Naser Ahmadi, MD, and Ramin Ebrahimi, MD, co-principal investigators of the study, said that their results suggest that physicians should provide early and aggressive evaluation and treatment of cardiovascular risk factors in patients with PTSD. Ahmadi, a scientist at the Greater Los Angeles Veterans Administration Medical Center, said, “This study for the first time appears to point to the mechanism for the cardiovascular part of that excess mortality risk: accelerated atherosclerosis. Our trial is the first to make a direct association between PTSD and atherosclerotic coronary disease as measured by coronary artery calcification, a standard test that is commonly used in studies such as ours because it can be measured non-invasively.”

The researchers studied the electronic medical records of 286,194 veterans treated at VA medical centers in southern California and Nevada. The veterans, with an average age of 63, participated in conflicts dating to the Korean War. During an average follow-up of nearly10 years and after adjusting for age, gender, and cardiovascular risk factors, the researchers found that veterans diagnosed with PTSD had 2.41 times the rate of death from all causes compared to non-PTSD veterans -- making PTSD an independent predictor of death from all causes.

Although patients with PTSD made up only 10.6% of the entire group of veterans, 28.9% of veterans who died had PTSD. Researchers found that in a 637-veteran substudy that used a non-invasive technique to measure the amount of coronary artery calcium, 76.1% of veterans with PTSD showed at least some CAC, compared to 59% of non-PTSD veterans.

The PTSD veterans also had more severe disease of their arteries. Ebrahimi said, “On average, the coronary artery calcium was 448 in the PTSD patients as opposed to 332 in non-PTSD patients.” He said that in every risk category the patients with PTSD had a statistically significant higher CAC score than the non-PTSD patients.

After controlling for known cardiovascular risk factors and mental status, the researchers found that at every level of calcium build-up the PTSD vets had a higher risk of all-cause mortality. Among veterans with calcium buildup, those with PTSD had a 48% greater risk from any cause and a 41% greater risk of death due to cardiovascular disease compared to non-PTSD veterans. Ebrahimi acknowledged that there are limitations to the study, primarily that it is a retrospective study from a database. Because the study involved only veterans, Ebrahimi said it is unclear if the results can be applied to the general population.

Regardless of the source of the study population, the results did show there is a significant association between the presence of PTSD and coronary atherosclerosis independent of conventional risk factors. Ebrahimi said that “If the implication is -- and we have proof -- that PTSD is related to CAC then the next step would be—does any treatment make any difference with the PTSD patients? And that’s the next step we’re taking—to look at the interventions and outcomes in these patients.”

Because most of the PTSD patients are seen outside VA centers by primary care doctors, Ebrahimi said there needs to be an increased awareness of this disorder among health care professionals in primary care settings.