Posttraumatic stress disorder (PTSD) is known to be associated with a increased IHD risk in pre dominantly male populations or limited community samples. Women veterans represent a growing, yet understudied, population that has high levels of trauma exposure and unique risk of cardiovascular disease. But there is a lack of research on IHD and PTSD in this group. Incident IHD is defined as new-onset coronary artery disease, angina, or myocardial infarction.
Ramin Ebrahimi, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California, and colleagues aimed to determine the associations between PTSD and incident IHD among women veterans.
For the purpose, the researchers conducted a retrospective, longitudinal cohort study of the national Veterans Health Administration (VHA) electronic medical records. They tested a priori hypothesis that PTSD would be associated with greater risk of IHD onset.
The study included women veterans aged 18 years or older with or without PTSD who were patients in the VHA from January 1, 2000, to December 31, 2017. Those with no VHA clinical encounters after the index visit, IHD diagnosis at or before the index visit, and IHD diagnosis within 90 days of the index visit were excluded.
A total of 398 769 women veterans, 132 923 with PTSD and 265 846 never diagnosed with PTSD, were included in the analysis.
The researchers conducted propensity score matching on age at index visit, number of prior visits, and presence of traditional and female-specific cardiovascular risk factors and mental and physical health conditions to identify women veterans ever diagnosed with PTSD. They were matched in a 2:1 ratio to those never diagnosed with PTSD. Data analysis was done from October 1, 2018, to October 30, 2020.
Key findings of the study include:
- During median follow-up of 4.9 (interquartile range, 2.1-9.2) years, 4381 women with PTSD (3.3%) and 5559 control individuals (2.1%) developed incident IHD.
- In a Cox proportional hazards model, PTSD was significantly associated with greater risk of developing IHD (hazard ratio [HR], 1.44).
- Secondary stratified analyses indicated that younger age identified women veterans with PTSD who were at greater risk of incident IHD.
- Effect sizes were largest for those younger than 40 years at baseline (HR, 1.72) and decreased monotonically with increasing age (HR for ≥60 years, 1.24).
"This cohort study found that PTSD was associated with increased risk of IHD in women veterans and may have implications for IHD risk assessment in vulnerable individuals," concluded the authors.
The study titled, "Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans," is published in the journal JAMA Cardiology.
DOI: https://jamanetwork.com/journals/jamacardiology/article-abstract/2777415
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