A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women.

Posttraumatic stress disorder (PTSD) reflects a prolonged stress reaction and dysregulation of the stress response system (Vanitallie, 2002). Evidence that dysregulated stress responses are associated with atherosclerosis and other cardiovascular system damage has suggested that PTSD may increase risk of developing coronary heart disease (CHD) (Rozanski, Blumenthal, Davidson, Saab, & Kubzansky, 2005). In a recent prospective study among older men who served in the military, risk of incident CHD was greater among men with higher versus lower levels of PTSD symptoms (Kubzansky, Koenen, Spiro, Vokonas, & Sparrow, 2007). Although PTSD is highly prevalent among war veterans (Hoge, Castro, Messer, McGurk, Cotting, & Koffman, 2004), it is also common in the general population and in fact is more prevalent among women (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). Women’s risk of developing PTSD is twice that of men; one in nine women will develop PTSD at some point in their lives (Kessler et al., 2005). Given that CHD is the leading cause of death among older women (Rosamond et al., 2007), the relation of PTSD and CHD incidence in women deserves closer attention. Though health-damaging effects of PTSD are hypothesized to be similar for men and women, no prospective studies have examined PTSD in relation to CHD risk among women or in a nonmilitary population. PTSD is defined by the combination of exposure to a traumatic event and the occurrence of three types of symptoms: reexperiencing the traumatic event, avoidance of traumatic reminders and emotional numbing, and hyper-arousal. Though much of the work on PTSD and cardiovascular risk has been conducted among male combat veterans, there is little evidence to suggest that potential health-damaging effects of PTSD are constrained to this population. In the limited existing work that considers both men and women civilians with PTSD, a higher prevalence of cardiovascular disease and related risk factors has been documented (Spindler & Pedersen, 2005). Moreover, consistent with other work suggesting that PTSD rather than trauma exposure alone may mediate between trauma and risk of adverse health outcomes (Kang, Bullman, & Taylor, 2006), Dong and colleagues found that civilian men and women with numerous adverse childhood experiences were at greater risk of ischemic heart disease [Odds Ratio (OR) = 3.6, 95% Confidence Interval (CI)} = 2.4–5.3], an effect that was explained more completely by psychological distress than by traditional risk factors (Dong et al., 2004). The present study provides a prospective test of the hypothesis that PTSD symptoms are associated with increased risk of developing CHD among community dwelling women. Data are from the Baltimore cohort of the Epidemiologic Catchment Area (ECA) study, a survey of psychiatric disorders in the general population. Work in this and other samples has considered the relationship between depression or anxiety and CHD (Kubzansky & Kawachi, 2000; Pratt, Ford, Crum, Armenian, Gallo, & Eaton, 1996). To address concerns that an observed association between PTSD and CHD may be because of other forms of distress, this study also considers whether PTSD is related to CHD onset after taking account of depression or anxiety (measured separately from PTSD).