Medical Research: What is the background for this study? What are the main findings?
Dr. Sumner: Cardiovascular disease, which includes conditions like heart attack and stroke, is the leading cause of death worldwide. Stress has long been thought to increase risk of cardiovascular disease, and posttraumatic stress disorder (PTSD) is the quintessential stress-related mental disorder. Some individuals who are exposed to traumatic events, such as unwanted sexual contact, the sudden unexpected death of a loved one, and physical assault, develop PTSD, which is characterized by symptoms of re-experiencing the trauma (e.g., nightmares), avoidance of trauma reminders (e.g., avoiding thinking about the trauma), changes in how one thinks and feels (e.g., feeling emotionally numb), and increased physiological arousal and reactivity (e.g., being easily startled). PTSD is twice as common in women as in men; approximately 1 in 10 women will develop PTSD in their lifetime. Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men.
My colleagues and I wanted to see whether PTSD was associated with the development of cardiovascular disease in a large sample of women from the general public. We looked at associations between PTSD symptoms and new onsets of heart attack and stroke among nearly 50,000 women in the Nurses’ Health Study II over 20 years, beginning in 1989. Women with the highest number of PTSD symptoms (those reporting 4+ symptoms on a 7-item screening questionnaire) had 60% higher rates of developing cardiovascular disease (both heart attack and stroke) compared to women who were not exposed to traumatic events. Unhealthy behaviors, including lack of exercise and obesity, and medical risk factors, including hypertension and hormone replacement use, accounted for almost 50% of the association between elevated PTSD symptoms and cardiovascular disease. We also found that trauma exposure alone (reporting no PTSD symptoms on the screening questionnaire) was associated with elevated cardiovascular disease risk compared to no trauma exposure.
Our study is the first to look at trauma exposure and PTSD symptoms and new cases of cardiovascular disease in a general population sample of women. These results add to a growing body of evidence suggesting that trauma and PTSD have profound effects on physical health as well as mental health.
Medical Research: What should clinicians and patients take away from your report?
Dr. Sumner: PTSD is not exclusively a psychological problem but also increases risk of chronic disease. Treatment providers, including primary care physicians, serving individuals at risk for PTSD should screen for cardiovascular risk and monitor health indicators in those with PTSD. Treatment for PTSD also needs to consider the long-term health consequences of the disorder. Ultimately, integration of mental and physical health care is key. Women with PTSD should be aware that they may be at elevated risk of developing a heart attack or stroke and that engaging in unhealthy behaviors, like smoking cigarettes and eating an unhealthy diet, may increase this risk.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Sumner: Our results suggest that women with PTSD are at increased risk of developing cardiovascular disease. Future research efforts should be focused on understanding why women with PTSD are at higher risk and how to prevent this increased risk. It is also of interest to study whether treatment for PTSD helps to reduce cardiovascular risk.
Jennifer A. Sumner, Ph.D., Columbia University Mailman School of Public Health, & New York, NY 10032 (2015). Women With PTSD At Higher Risk For Heart Disease