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Long-Term Mortality Risks in Veterans with PTSD

PTSD may be bad for your heart.

Investigators are uncovering the long-term consequences of post-traumatic stress disorder. In a large-scale, prospective, community-based, epidemiologic study of Vietnam-era veterans, a baseline diagnosis of PTSD was associated with higher rates of alcohol abuse, major depression, and antisocial personality disorder. In this 16-year follow-up of the same sample, researchers looked at the effect of PTSD on heart disease. Participants with severe baseline heart disease (e.g., myocardial infarction or congestive heart failure) were excluded, allowing analysis of 4328 men.

Over follow-up, 52 deaths from ischemic heart disease were identified. A baseline diagnosis of PTSD more than doubled the risk for mortality related to ischemic or atherosclerotic heart disease before age 65. Even after adjustment for traditional risk factors (e.g., smoking, obesity, and depression), a PTSD diagnosis in individuals free of heart disease at baseline independently increased mortality risk, and the size of this risk correlated to PTSD severity. Risk further increased with combat exposure.

Comment: The risk for early death due to heart disease is relatively low overall in this study, but the increased risk that is independently associated with PTSD remains noteworthy. Inflammatory processes associated with hypothalamic-pituitary-adrenal axis activation have been postulated as potential mechanisms contributing to atherosclerosis in individuals with PTSD.

In an earlier report based on this sample, nearly 10% of those in the combat theater later met screening criteria for a PTSD diagnosis. With high numbers of veterans returning from Iraq and Afghanistan with PTSD, clinicians have many opportunities for early interventions and better ongoing surveillance that may help reduce risks for the many long-term negative PTSD sequelae, including early mortality.

— Joel Yager, MD

Published in Journal Watch Psychiatry August 25, 2008

Citation(s):

Boscarino JA. A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: Implications for surveillance and prevention. Psychosom Med 2008 Jul; 70:668.

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• Medline abstract (Free)

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Review and add to remarks on this article

• PTSD, Ischemic Heart Disease and Agent Orange
  Rchard A. Valdez, Retired on SSI/VA Comp, 12 Aug 2009 4:52 PM EST
  Have there been any studies that correlate PTSD and Agent Orange as contributors to IHD, and if so is it... [more]
• A response from JW Associate Editor Joel Yager, MD
  Joel Yager, MD, Professor, Department of Psychiatry, School of Medicine, University of Colorado, 20 Aug 2009 12:30 PM EST
  I did a brief search and found a citation to an article that seems to address this issue. The citation... [more]

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