Women who suffer traumatic events or develop posttraumatic stress disorder (PTSD) are at increased risk of developing cardiovascular disease (CVD), according to new data from a long-running study of US nurses.

“PTSD is not exclusively a psychological problem but also increases risk of chronic disease,” lead author Jennifer A. Sumner, PhD, of Columbia University Mailman School of Public Health, in New York City, told Medscape Medical News.

“Treatment providers serving individuals at risk for PTSD, including primary care physicians, should screen for cardiovascular risk and monitor health behaviors in those with PTSD. Psychological treatment for PTSD also needs to consider the long-term health consequences of the disorder. Ultimately, integration of mental and physical healthcare is key,” Dr Sumner added.

The study was published online June 29 in Circulation.

Mind-Body Connection

The researchers assessed trauma exposure and PTSD symptoms in relation to incident CVD during 2 decades in nearly 50,000 women in the Nurses’ Health Study II. During that time, 548 probable or definite CVD events were logged, including 277 myocardial infarctions and 271 strokes.

After adjusting for age, family history, and childhood factors, women reporting four or more PTSD symptoms had 60% higher rates of developing CVD compared with women who were not exposed to traumatic events (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.20 - 2.13).

Women who were exposed to trauma but who had no PTSD symptoms were also at heightened risk for CVD compared with those who were not exposed to trauma (HR, 1.45; 95% CI, 1.15 - 1.83).

Unhealthy behaviors, including lack of exercise and obesity, and medical risk factors, including hypertension and use of hormone replacement therapy, accounted for 47% of the association between elevated PTSD symptoms and CVD and about 14% of the association between trauma/no PTSD and CVD.

“Stress has long been thought to increase risk of cardiovascular disease, and PTSD is the quintessential stress-related mental disorder,” Dr Sumner commented. “PTSD is twice as common in women as in men; approximately 1 in 10 women will develop PTSD in their lifetime. Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men. Our study is the first to look at trauma exposure and PTSD symptoms and new cases of CVD in a general population sample of women,” she said.

Screen for PTSD

Commenting on the findings for Medscape Medical News, Suzanne Steinbaum, MD, director, Women’s Heart Health, Heart and Vascular Institute, Lenox Hill Hospital, New York City, and a spokesperson for the American Heart Association, said the study is another in a series highlighting the significant impact of emotion on the heart, especially in women.

“We know that anxiety and depression increase the risk of heart disease in women. When we don’t talk about traumatic events with our patients, I think we really are missing out on a huge piece of what could be affecting a woman’s heart,” Dr Steinbaum said. “We should also understand that we can treat PTSD. It’s not just about prevention of heart disease, it’s really about dealing with the issue.”

Steven R. Thorp, PhD, University of California, San Diego, and program director, PTSD Clinical Team, Veterans Affairs San Diego Healthcare System, agrees.

“If someone screens positive for PTSD, I think it makes sense for them to note the risk for cardiovascular disease as well, not just if they have PTSD but if they have been exposed to any trauma. We certainly don’t do that clinically now,” he noted in an interview with Medscape Medical News. “And vice versa, a lot of folks who have any signs of cardiovascular disease aren’t typically screened for PTSD. They are more often screened for general stress but not PTSD,” said Dr Thorp, who also was not involved in the study.

He noted that oftentimes, older adults with PTSD may in particular be treated in primary care for things that “kind of look like PTSD, like headaches or stomachaches or trouble sleeping, but they actually don’t get treated for PTSD.”

Dr Thorp also noted that some of the association between trauma or PTSD in this study was explained by unhealthy health behaviors and medical risk factors. “It doesn’t explain it all, and so there might be something else going on physiologically that is common to both PTSD and these other issues.”

The study was funded by the National Institutes of Health. The authors and commentators report no relevant financial relationships.

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Circulation. Published online June 29, 2015. Abstract