Posttraumatic stress disorder (PTSD) is an anxiety disorder initiated by exposure to a traumatic event and characterized by intrusive thoughts about the event, attempts to avoid reminders of the event, and physiological hyperarousal. In a number of large prospective observational studies, PTSD has been associated with incident cardiovascular disease (CVD) and mortality. Also, in recent years, a number of studies have shown that cardiovascular events can themselves cause PTSD in more than 1 in 8 patients with acute coronary syndrome. Further, a few small studies suggest that PTSD secondary to an acute CVD event then places patients at increased risk for subsequent CVD events and mortality. In this article, we review the evidence for a link between PTSD and CVD, and discuss potential mechanisms for that association as well as future directions for research.Posttraumatic stress disorder is an anxiety disorder initiated by an exposure to a traumatic event, such as combat, natural disaster, or sexual assault, and is characterized by symptoms such as re-experiencing the traumatic event (e.g., intrusive thoughts, nightmares), cognitive or behavioral avoidance of reminders of the event, and physiological hyperarousal. It is associated with abnormal amygdala, prefrontal cortex, and hippocampal function 1 as well as abnormal neuroendocrinologic characteristics. 2 Increasingly, PTSD is also being recognized as an independent risk factor for cardiovascular disease (CVD). [3][4][5] This paper outlines our current understanding of the association of PTSD and CVD, and considers 2 propositions concerning the association: (1) PTSD due to traumatic life events increases risk for incident CVD, and (2) the experience of life-threatening CVD may cause PTSD, and increase recurrent CVD risk.
PTSD and risk for incident CVD/mortalityIn recent years, evidence has accumulated that PTSD due to various types of traumatic experiences, including exposure to combat, the World Trade Center attacks, and other similar life-threatening events is associated with development of cardiovascular disease, acute coronary syndromes, and cardiac-specific mortality. To date, 5 prospective cohort