PTSD Linked to Increased Risk of Ischemic Heart Disease in Women Veterans

Ramin Ebrahimi, MD

Traumatic events that yield post-traumatic stress disorder (PTSD) might also increase the risk of ischemic heart disease (IHD) for women.

A team, led by Ramin Ebrahimi, MD, Department of Medicine, Cardiology Section, Veterans Affairs Greater Los Angeles Health Care System, determined the association between PTSD and ischemic heart disease in women veterans.

PTSD is a known risk factor for ischemic heart disease in male populations or limited community samples. However, this connection in women veterans is understudied.

The Participants

In the retrospective, longitudinal cohort study, the investigators used data from the national Veterans Health Administration (VHA) electronic medical records for 398,769 veteran women with a baseline mean age of 40.1 years old. The patient population was women veterans with or without PTSD between 2000-2017.

Overall, there were 132,923 individuals in the study with PTSD and 265,846 never diagnosed with PTSD.

The study organizers excluded patients with no VHA clinical encounters after the index visit, ischemic heart disease diagnosis at or before the index visit, and IHD diagnosis within 90 days of the index visit.

The researchers identified women veterans diagnosed with PTSD using propensity score matching on age at index visit, number of prior visits, and presence of traditional and female-specific cardiovascular risk factors and mental and physical health conditions.

The investigators sought main outcomes of incident ischemic heart disease, defined as new-onset coronary artery disease, angina, or myocardial infarction, based on ICD-9 and ICD-10 diagnosis codes from inpatient or outpatient encounters, and/or coronary interventions based on Current Procedural Terminology codes.

Final Analysis

During the final analysis, there was a median follow-up of 4.9 years, with 4381 participants with PTSD (3.3%) and 5559 control participants (2.1%) developing incident IHD.

After using a Cox proportional hazards model, the investigators found PTSD was significantly associated with greater risk of developing IHD (HR, 1.44; 95% CI, 1.38-1.50).

After using a secondary stratified analysis, the investigators found younger patients with PTSD were at a greater risk of incident IHD and effect sizes were largest for participants younger than 40 years old at baseline (HR, 1.72; 95% CI, 1.55-1.93) and decreased monotonically with increasing age (HR for ≥60 years, 1.24; 95% CI, 1.12-1.38).

“This cohort study found that PTSD was associated with increased risk of IHD in women veterans and may have implications for IHD risk assessment in vulnerable individuals,” the authors wrote.

Other Links

Last year, researchers from Emory University is shedding light on a potential link between PTSD and mental stress-induced myocardial ischemia in patients with stable coronary artery disease.

Patients with PTSD had greater rates of ischemia with mental stress than those without PTSD (27.3% vs. 14.7%; P=.04) and more than twice the mean number of ischemic segments (1.2 [95% CI, 0.5-1.8] vs. 0.5 [95% CI, 0.3-0.7]; P <.001). Conversely, there was no difference between the groups in regards to conventional stress ischemia (22.7% vs. 23.2%; P=.91).

The study, “Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans,” was published online in JAMA Cardiology.