Ramin Ebrahimi, MD, Department of Medicine, Cardiology Section, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California, and Department of Medicine, UCLA (University of California, Los Angeles) speaks about the Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans.

Link to Abstract:
https://jamanetwork.com/journals/jamacardiology/article-abstract/2777415


Points to Remember:

Inquiry Is a history of posttraumatic stress disorder (PTSD) related to an increased risk of ischemic heart disease (IHD) in female veterans?


Findings: Those with PTSD had a 44 percent higher risk of developing incident IHD in this longitudinal cohort analysis of 398 769 women veterans, including 132 923 with PTSD matched 1:2 to 265 846 without PTSD. Various risk factors, including common and female-specific cardiovascular risk factors, as well as mental and physical health conditions, were taken into account using propensity score matching.



Meaning: These results indicate that among female veterans, PTSD is linked to an increased risk of experiencing incident IHD.



Synopsis:

The significance of In primarily male populations or small group studies, posttraumatic stress disorder (PTSD) is linked to an increased risk of ischemic heart disease (IHD). Women veterans are an increasing but understudied demographic with high trauma exposure and specific cardiovascular risks, but there is little research on PTSD and IHD in this community.



The aim of this study was to see if PTSD is linked to incident IHD in female veterans.



Participants, Design, and Setting The a priori hypothesis that PTSD would be associated with a higher risk of IHD onset was tested in this retrospective, longitudinal cohort analysis of the national Veterans Health Administration (VHA) electronic medical records. Women veterans aged 18 and up, with or without PTSD, who were patients at the VHA between January 1, 2000, and December 31, 2017, were considered for the report. No VHA clinical experiences after the index visit, IHD diagnosis at or before the index visit, and IHD diagnosis within 90 days of the index visit were all exclusion criteria. Women veterans ever diagnosed with PTSD were compared in a 1:2 ratio to those never diagnosed with PTSD using propensity score matching based on age at index visit, number of previous visits, and prevalence of traditional and female-specific cardiovascular risk factors and mental and physical health conditions. From October 1, 2018, to October 30, 2020, data was analyzed.



PTSD diagnosis codes from inpatient or outpatient encounters, as specified by the International Classification of Diseases, Ninth Revision (ICD-9), or the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10).



Incident IHD, classified as new-onset coronary artery disease, angina, or myocardial infarction, based on ICD-9 and ICD-10 diagnosis codes from inpatient or outpatient experiences, and/or coronary procedures based on Current Procedural Terminology codes, are the main outcomes and measures.



The study included 398 769 women veterans, 132 923 of whom had PTSD, and 265 846 who had never been diagnosed with PTSD. The mean (SD) age at the start was 40.1 (12.2) years. 4381 women with PTSD (3.3%) and 5559 control persons (2.1%) developed incident IHD over a median follow-up of 4.9 (interquartile range, 2.1-9.2) years. In a Cox proportional hazards model, PTSD was linked to a higher risk of developing IHD (hazard ratio [HR], 1.44; 95 percent confidence interval [CI], 1.38-1.50). Secondary stratified tests revealed that women veterans with PTSD who were younger were at a higher risk of incident IHD. At baseline, effect sizes were highest for those under 40 years old (HR, 1.72; 95 percent CI, 1.55-1.93), and they decreased monotonically with age (HR for those 60 years old, 1.24; 95 percent CI, 1.12-1.38).



Conclusions and Consequences: This cohort study discovered that PTSD was linked to an increased risk of IHD in female veterans, which may have implications for assessing IHD risk in vulnerable people.