Posttraumatic Stress Disorder, Cardiovascular, and Metabolic Disease: A Review of the Evidence

Abstract

Background Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease. Purpose The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes. Methods A systematic literature search in the period of 2002–2009 for PTSD, cardiovascular disease, and metabolic disease was conducted. Results The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers. Conclusions Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.

Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond

“…Importantly, although many will experience a traumatic event in their lifetime (70% of the general population), only 7.8% of the US population will go on to develop PTSD in the aftermath of trauma (Keane et al, 2009). PTSD is associated with significant co-morbidities including major depression, substance and alcohol abuse, PD, suicide, reduced life expectancy, as well as disability in daily activities, and increased health care utilization (Dedert et al, 2010;Khoury et al, 2010;Norrholm et al, 2011). Adverse physical health co-morbidities are also common in individuals with PTSD, including obesity, diabetes, cardiovascular disease (Boscarino, 2004;Coughlin, 2011;Heppner et al, 2009).…”

D-Cycloserine Augmentation of Exposure Therapy for Post-Traumatic Stress Disorder: A Pilot Randomized Clinical Trial

“…Yet, PTSD is a significant public health problem with an estimated 8-9% of the population at risk for at least one episode during their lifetime (Hidalgo and Davidson, 2000;Kessler et al, 1995;Yule, 2001). PTSD is associated with multiple adverse outcomes, including psychiatric comorbidity, marital discord, medical illness (Dedert et al, 2010), absenteeism (Alonso et al, 2011), suicide (Kessler, 2000), and an estimated annual productivity loss of approximately $3 billion (Kessler, 2000).…”

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

“…Moreover, in the Framingham Coronary Heart Disease study, patients with PTSD were found to have increased Framingham risk scores for CVD (40). To date, there have been six PTSD-CVD prospective studies completed, following participants from 1 to 30 years, which have demonstrated consistent associations between PTSD and CVD after adjusting for demographic, clinical, and psychosocial factors, including depression (15,44,57,58,89,96).There are multiple risk factors (stroke, hypertension, atherosclerosis, and obesity metabolic syndrome) for the development of CVD, and increases in the incidence of these risk factors are often associated with PTSD (1,22,30,51,111 In a 14-year prospective study of more than 1,900 patients, men had an increased risk for both nonfatal myocardial infarction and fatal coronary heart disease with every SD increase in symptom level; similarly, women with five or more PTSD symptoms had over three times the risk of incidence of CVD (57, 58). It is also worth noting that clinically significant PTSD symptoms can be induced by cardiovascular related events, and these individuals are more likely to have recurrent major adverse coronary events (24, 59).…”

“…There are multiple risk factors (stroke, hypertension, atherosclerosis, and obesity metabolic syndrome) for the development of CVD, and increases in the incidence of these risk factors are often associated with PTSD (1,22,30,51,111 In a 14-year prospective study of more than 1,900 patients, men had an increased risk for both nonfatal myocardial infarction and fatal coronary heart disease with every SD increase in symptom level; similarly, women with five or more PTSD symptoms had over three times the risk of incidence of CVD (57, 58). It is also worth noting that clinically significant PTSD symptoms can be induced by cardiovascular related events, and these individuals are more likely to have recurrent major adverse coronary events (24, 59).…”