The Aftermath of Trauma

Understanding post-traumatic stress

PTSD and Coronary Heart Disease

Do PTSD-induced emotional triggers increase risk for coronary heart disease?

Image: Jared Rodriguez / t r u t h o u t

Recent research published in the Journal of the American College of Cardiology presented findings which appeared to support what many of us who spend our days treating those living with PTSD long suspected: a fascinating correlation between the health of the mind/brain and its direct impact on one’s physical wellbeing.

The study followed male twins (from the Vietnam Era Twin Registry) for 13 years, in a prospective study, and investigated whether the presence of PTSD increased the risk for coronary heart disease (CHD) in these participants. The researchers selected 281 pairs of twins (a mix of fraternal and identical) who were discordant for a lifetime history of PTSD. (The use of twin participants allowed the researchers to better control for influences of genetics and environment.)

The outcome measures, in terms of impact on heart health, were presence of 1) myocardial infarction (heart attack) 2) other hospitalization for CHD related symptoms 3) need for an intervention such as coronary revascularization.

The researchers found the incidence of CHD was more than double in twins with PTSD than those without. This, even after controlling for the other “usual suspects” we think of when we think of CHD, e.g. lifestyle factors such as smoking or level of physical activity, other CHD risk factors, and other mental health conditions also associated with CHD such as Major Depression.

The researchers hypothesized that the repeated emotional triggers during everyday life in persons with PTSD could affect the heart by causing frequent increases in blood pressure and heart rate that contributed to the development of CHD.

Whilst the exact biological mechanisms involved remain unknown, this fascinating research finding highlights the need for answers to other related questions such as: Does this association hold true for other populations, such as women? Or to PTSD associated with non-combat related PTSD? Can the cardio toxic effects of PTSD be reversed if the PTSD is successfully treated?

Whilst it has long been hypothesized that PTSD is associated with physical health problems, previous studies investigating this relationship have been flawed for retrospective designs, use of participant self-report, and not adjusting for confounding factors e.g. presence of comorbid mental health disorders known to contribute to health problems/other behavioral risk factors commonly associated with PTSD i.e. cigarette smoking/substance abuse.

One clear pearl for clinical practice which emerges from this type of research is that mental health professionals have to increase their level of collaboration with primary and specialty medical care providers in order to better address this relationship between mental health disorders and physical health problems. This research should also provide food for thought for those who have been skeptical that psychological wellbeing can directly influence physical health outcomes.

Copyright: Shaili Jain, MD. For more information, please see PLOS Blogs

Shaili Jain, M.D., a professor of psychiatry at Stanford, is the Medical Director of the Primary Care-Behavioral Health Team, VA Palo Alto.

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