Posttraumatic Stress Disorder and Cardiovascular Disease

Abstract

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

Cardiovascular Disease Risk Factors in Patients With Posttraumatic Stress Disorder (Ptsd): A Narrative Review

“…Smoking behavior might also differ in patients with PTSD, in terms of more difficult smoking cessation and stronger withdrawal symptoms (Kelly et al 2015). Similar findings have been reported on the alcohol and other toxic substances' abuse in this population, also linking it to self-medication of anxiety and hyperarousal symptoms (Edmondson & Cohen 2013). In addition, a recent meta-analysis has confirmed an association between PTSD and increased BMI .…”

“…Similarly, in a sample of 501 Croatian war veterans suffering from PTSD, aged between 36 and 65 years, the incidence of arterial hypertension, cardiac arrhythmias and myocardial infarction was significantly higher compared to a healthy control group (Britvi et al 2015). It is now well-established that PTSD is independently associated with increased risk for coronary artery disease and related mortality (Edmondson & Cohen 2013, Edmondson et al 2013). Moreover, among veterans treated in an outpatient clinic, those with PTSD had worse indicators of endothelial function (Grenon et al 2016), which might have contributed to the early onset and progression of CVD in this population.…”

Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease

“…The health consequences of PTSD are substantial, affecting multiple organ systems, with evidence linking PTSD to diseases such as cancer, arthritis, digestive disease, and cardiovascular disease (CVD) (13,14,112). The evidence demonstrating increased risk for CVD in PTSD (9,15,19,49,57,58) is compelling, and several excellent recent review articles have highlighted this association (20,23,52,63,112). While this association could certainly be due, in part, to related unhealthy behaviors, such as increased prevalence of smoking, poor diet, and physical inactivity (46,119).…”

A Clinical Pathway through Substance Use Disorder, First Episode Psychosis to Post Traumatic Stress Disorder on the Basis of HPA Axis Dysfunction

“…Abnormal basal cortisol levels and reactivity are implicated in SUD, PTSD and FEP as a result of hypothalamic-pituitary-adrenal (HPA) axis dysfunction. [8][9][10] This finding and an understanding of potential mechanisms implicated within each entity are explored to further illuminate associated risk factors, as well as a clinical pathway among and co-existence of these conditions. Finally, the possibility of an FEP resulting as a discrete experience from SUD, rather than an additional disorder, is discussed.…”