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Laura D. Kubzansky, PhD; Karestan C. Koenen, PhD; Avron Spiro III, PhD; Pantel S. Vokonas, MD; David Sparrow, DSc

Arch Gen Psychiatry. 2007;64(1):109-116.

Context  Various correlates of posttraumatic stress disorder (PTSD), such as high levels of sympathetic activation and hypothalamic-pituitary-adrenal axis dysregulation, have been linked to arterial damage and coronary heart disease (CHD) risk. While psychological disturbance is frequently found among patients with cardiac disease, whether psychological problems precede or occur as a result of having a potentially fatal disease is not clear. To our knowledge, no prospective studies to date have evaluated whether PTSD is associated with increased risk of CHD.

Objective  To test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using 2 different measures of PTSD.

Design  Prospective cohort study.

Setting  Community-dwelling men from the Greater Boston, Mass, area who served in the military.

Participants  Data are from the Veterans Affairs Normative Aging Study. Men who completed either the Mississippi Scale for Combat-Related PTSD in 1990 (n = 1002) or the Keane PTSD scale in 1986 (n = 944) were included in the study.

Main Outcome Measure  Incident CHD occurring during follow-up through May 2001.

Results  Levels of PTSD symptoms in this cohort were low to moderate. Men with preexisting CHD at baseline were excluded, and PTSD was measured with the Mississippi Scale for Combat-Related PTSD. For each SD increase in symptom level, men had age-adjusted relative risks of 1.26 (95% confidence interval, 1.05-1.51) for nonfatal myocardial infarction and fatal CHD combined and 1.21 (95% confidence interval, 1.05-1.41) for all of the CHD outcomes combined (nonfatal myocardial infarction, fatal CHD, and angina). Findings were replicated using the Keane PTSD scale and somewhat strengthened after controlling for levels of depressive symptoms.

Conclusions  To our knowledge, this is the first study to demonstrate a prospective association between PTSD symptoms and CHD even after controlling for depressive symptoms. These results suggest that a higher level of PTSD symptoms may increase the risk of incident CHD in older men.

Author Affiliations: Harvard School of Public Health (Drs Kubzansky and Koenen), Veterans Affairs Normative Aging Study, Veterans Affairs Boston Health Care System, Boston University School of Medicine (Drs Koenen, Vokonas, and Sparrow), Boston University School of Public Health (Drs Spiro, Vokonas, and Sparrow), and Channing Laboratory and Harvard Medical School (Dr Sparrow), Boston, Mass.

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