Post-traumatic stress disorder and cardiovascular disease

Abstract

This work is a narrative review of the evidence for an association of PTSD with incident cardiovascular disease (CVD) risk and the mechanisms that may carry that association, as well as the prevalence of PTSD due to CVD events and its associated prognostic risk. We discuss new research conducted since the publication of previous relevant systematic reviews and survey currently funded research in the portfolios of the two most active funders in the field. We conclude that PTSD is a risk factor for incident CVD, and a common psychiatric consequence of CVD events that may worsen CVD prognosis. There are many candidate mechanisms for the PTSD-CVD link, and a number of ongoing studies may soon point to the most important behavioral and physiological mechanisms to target in early phase intervention development. Similarly, targets are emerging for both individual and environmental interventions that may offset PTSD risk after CVD events.

Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome: The MI-SPRINT Randomized Controlled Trial

“…Moreover, a reanalysis of data from the above-mentioned observational sample [12] revealed a prevalence of interviewer-rated PTSD as high as 10.3% in the subsample of 39 patients who were assessed between 2 and 4 months after ACS with scores for pain, fear of dying, and helplessness corresponding to the eligibility criteria for MI-SPRINT. Without any scientific advisory for the management of patients with a high level of distress during ACS [6], the natural onset of ACS-induced PTSS/PTSD must currently be viewed the most accurate outcome estimate of usual care for these patients. Therefore, a parsimonious interpretation of the main results from our RCT may be that both active interventions were more effective for the prevention of ACS-induced PTSS/PTSD than the current standard care of patients with high distress during ACS.…”

“…Unfavorable health behaviors, low adherence to cardiac therapy, psychiatric comorbidity, sleep disturbances, and direct pathophysiologic and cardiometabolic effects have been postulated as mechanisms contributing to poor prognosis [6].…”

“…Owing to the health consequences of ACS-induced posttraumatic stress, early interventions to lower the incidence of PTSD seem reasonable but such studies are lacking [6], one important reason for this being the challenge to choose the appropriate intervention for these patients. Single-session individual early debriefing aims at alleviating stress reactions within several hours or days of trauma exposure, but it did not reduce psychological distress or prevent PTSD onset [7,8], so debriefing is not recommended anymore [9].…”

Recent Genetics and Epigenetics Approaches to PTSD

“…A number of elegant algorithms and software packages exist to run these analyses [105, 106], and PheWAS catalogs are openly available [107]. Testing PTSD-associated variants and genes using this approach may substantiate epidemiological observations about comorbid phenotypes (for example, an increased risk of cardiovascular disease [70, 108, 109]), and clarify whether these comorbidities are due to shared genetic etiology, some shared effect of exposure to trauma, PTSD treatment, or some other factor. The longitudinal aspect of EHRs will also allow researchers to track whether comorbid conditions precede PTSD onset or trauma exposure, as well as whether symptoms persist after treatment for PTSD.…”

Post-traumatic stress disorder and cancer

“…2–10 PTSD has also been documented following myocardial infarction, cerebrovascular accidents, HIV infection, burns, and other medical stressors. 11–13 Changes in the DSM-5 14 PTSD diagnostic criteria have important implications for assessment of cancer-related PTSD, 15 but research with the updated criteria is limited. Here, we review cancer-related PTSD literature, highlight conceptual, methodological, and diagnostic issues, and identify clinical implications and areas for future research (panel 1).…”