PTSD Linked with Higher Heart Disease Risk

Post-traumatic stress disorder (PTSD) may increase the risk of heart disease, a new study suggests. The study included 562 male twins. All were part of a health registry of veterans from the Vietnam era. The men were an average of 42 years old and did not have heart disease when the study began. In the next 13 years, about 23% of men with PTSD developed heart disease. The rate was 9% among those without PTSD. Heart disease was defined as having a heart attack, other heart-related hospital stay or a procedure to open clogged arteries. Researchers also compared twin pairs in which one had PTSD and the other did not. The twins with PTSD were twice as likely to develop heart disease. Researchers adjusted their numbers for lifestyle factors that affect heart disease risk, such as smoking and exercise patterns. The differences for those with PTSD remained. Men with PTSD also were not more likely to have high blood pressure, diabetes or other conditions that increase heart disease risk. The Journal of the American College of Cardiology published the study online, USA Today and MedPage Today wrote about it June 25.

By Reena L. Pande, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

We have long understood that there are links between mental health and physical health. The effects of lifestyle and overall well-being on heart health are abundantly clear.

People who feel depressed or anxious can have trouble coping with new medical issues, such as heart attacks. They are also likely to have trouble taking their medicines regularly. They may be less like to seek out follow-up care. And as a result, they may find themselves in the hospital with repeat heart problems more often.

Studies have also suggested that mental health issues could be a cause of heart disease. A new study published this week suggests that post-traumatic stress disorder (PTSD) might make people up to twice as likely to develop heart disease.

The study looked at sets of twins from the Vietnam Era Twin Registry, 562 people in all. During a 13-year period, nearly 1 out of 4 of those who had PTSD developed heart disease. Fewer than 1 out of 10 without PTSD developed heart disease. This was confirmed by nuclear scans. These are tests that heart doctors can do to look at the blood flow to the heart.

Researchers also compared twin sets. If one twin had PTSD and the other did not, the risk of heart disease was nearly double for the twin with PTSD.

These findings were not explained just by differences in lifestyle factors, such as smoking and physical activity levels. Researchers also found no links between PTSD and the usual risk factors for heart disease, such as high blood pressure, diabetes or obesity. Together, these results suggest that mental health concerns like PTSD may have a direct effect on the heart.

What Changes Can I Make Now?

PTSD affects more than 7 million adults in the United States. It is an anxiety disorder that can develop in a small number of people after they go through severe trauma. People with PTSD continue to feel stressed and afraid even when they are no longer in danger.

The first step toward treatment is to recognize the symptoms of PTSD. They can include:

• Having the symptoms of fear and anxiety all over again -- Flashbacks and bad dreams might be triggered by words, situations, sounds or images.
• Wanting to avoid certain situations -- Some people with PTSD try to stay away from places or events that might remind them of prior experiences.
• Being easily startled or aroused, tense or on edge
• Feeling guilt or worry
• Having symptoms of depression, such as:
  • Lack of interest in activities that were previously enjoyable
  • Not sleeping well
  • Being unable to concentrate
  • Not eating well

Some things can help reduce the likelihood of developing PTSD:

• Finding a support group or seeking support from friends and family
• Feeling good about yourself
• Developing strategies for coping

There are multiple types of treatments for PTSD. Every person is different. What works for one person may be different from what works for another. Some people may need to try various treatments before finding what works best for them.

One major type of treatment is behavioral therapy. This means speaking with a mental health professional to help develop strategies for managing PTSD. Medicines also are used sometimes.

It appears that PTSD and other mental health concerns can increase the risk of heart disease. So, if you have PTSD, think about how to lower your risk of heart disease. Steps you can take include controlling high blood pressure, high cholesterol and diabetes. Healthy lifestyle changes also can lower your risk. These include not smoking, eating a healthy diet and increasing physical activity.

What Can I Expect Looking to the Future?

Our health care system needs to do better at recognizing and treating mental health issues such as PTSD. We also need a better understanding of why PTSD might increase the risk of developing heart disease.

Future research should attempt to understand if better treatment of mental health issues might lead to lower risk of heart disease. We already know that improving care of depressed patients after they have a heart attack can make a big difference in improving heart outcomes. The next step will be to find innovative ways to reach out to people with mental health issues. We also must provide the tools they need to get healthy and prevent heart disease.