People with post-traumatic stress disorder may be at a higher risk for heart disease, according to researchers. In a study of US war veterans, they found that those with PTSD were more likely to have plaque in their coronary arteries.
The disease had also progressed farther in the mentally troubled vets, and they were more likely to die of any cause over the next three and a half years than their peers.
Joseph Boscarino, an investigator at Geisinger Health System in Danville, Pennsylvania, said the new results confirm earlier findings.
Studies "keep showing this link between PTSD and various forms of cardiovascular disease," said Boscarino. "Something needs to be done in terms of better interventions" for these individuals, he added.
The military has already been under pressure to better address PTSD in returning troops, as accounts of vets plagued by combat flashbacks, fearful and avoidant behaviour, and depression have accumulated.
1 in 30 adults has PTSD
According to the National institute of Mental Health, about 1 in 30 adults in the US suffer from PTSD in a given year, and that risk is much higher in war vets.
The new results highlight the importance of integrating medical and psychological care in vets, and quickly identifying those who are at risk for PTSD and thus heart disease as well, the researchers said in their paper, published in The American Journal of Cardiology.
Dr Ramin Ebrahimi of the Greater Los Angeles Veterans Administration Medical Centre and colleagues screened 637 vets suspected of having heart disease for PTSD and signs of coronary artery disease.
The vets were an average of about 60 years old, and most were men. Eighty-eight of them fit the criteria for PTSD.
Calcium scans showed the majority had some sort of plaque build-up in their coronary arteries. More than 75% of the vets with PTSD had narrowed arteries, compared to 59% of those without PTSD.
After their initial tests, the researchers followed participants for an average of three and half years. Over that time, 17% of the vets with PTSD died, compared to 10% without PTSD.
Even among those with the same degree of plaque build-up, participants with PTSD died at a higher rate.
PTSD doesn’t cause heart disease
Although the study doesn't mean that PTSD necessarily causes heart disease, it does suggest that it's not enough to worry about the mental toll of the disorder.
"For the longest time (PTSD) was basically known as a psychological or psychiatric disorder," said Ebrahimi. "Little by little we understood that these patients actually do have a fair amount of other medical problems."
Boscarino said that it's still unclear what exactly is behind the link between mental and physical health.
It's possible that stress hormones related to PTSD could affect the chance of getting heart disease or that the behaviour of people with PTSD –such as higher rates of heavy alcohol use and smoking –puts them more at risk, he explained.
It could also be that certain genes influence a person's risk for both PTSD and heart disease, rather than PTSD causing heart problems, he added.
Dr Ebrahimi emphasized that PTSD strikes not only people involved in combat or other violence, but survivors of rape and natural disasters as well. Often, it can be treated successfully with psychotherapy.
According to Boscarino, screening for heart disease and trying to prevent it is key in people with PTSD. But addressing the psychological problems may be even more important.
"If you treat someone for PTSD early on...you should prevent not only the psychological problems, but you're also potentially preventing the medical problems" that may come later, he said.
(Reuters Health, Genevra Pittman, May 2011)
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