Molly Remch1,2, Zoey Laskaris1,3, Janine Flory4,5, Consuelo Mora-McLaughlin6, Alfredo Morabia7,6. 1. Barry Commoner Center for Health and the Environment, Queens College, City University of New York (M.R., Z.L., A.M.). 2. University of North Carolina Gillings School Of Global Public Health, Chapel Hill (M.R.). 3. University of Michigan School of Public Health, Epidemiology, Ann Arbor (Z.L.). 4. James J. Peters Veterans Affairs Medical Center, Bronx, NY (J.F.). 5. Department of Psychiatry, Icahn Mount Sinai School of Medicine, NY (J.F.). 6. Department of Epidemiology, Mailman School of Public Health, Columbia University, NY (C.M.-M., A.M.). 7. Barry Commoner Center for Health and the Environment, Queens College, City University of New York (M.R., Z.L., A.M.). am52@cumc.columbia.edu.
Abstract
BACKGROUND: We sought to determine whether post-traumatic stress disorder (PTSD) is a risk factor for myocardial infarction (MI) and stroke, beyond the expected effects from recognized cardiovascular risk factors and depression. METHODS AND RESULTS: World Trade Center-Heart is an observational prospective cohort study of 6481 blue-collar first responders nested within the World Trade Center Health Program in New York City. Baseline measures in 2012 and 2013 included blood pressure, weight and height, and blood lipids. PTSD, depression, smoking, and dust exposure during the 2001 cleanup were self-reported. During the 4-year follow-up, outcomes were assessed through (1) interview-based incident, nonfatal MI, and stroke, validated in medical charts (n=118); and (2) hospitalizations for MI and stroke for New York city and state residents (n=180). Prevalence of PTSD was 19.9% in men and 25.9% in women, that is, at least twice that of the general population. Cumulative incidence of MI or stroke was consistently larger for men or women with PTSD across follow-up. Adjusted hazard ratios (HRs) were 2.22 (95% confidence interval [CI], 1.30-3.82) for MI and 2.51 (95% CI, 1.39-4.57) for stroke. For pooled MI and stroke, adjusted HRs were 2.35 (95% CI, 1.57-3.52) in all and 1.88 (95% CI, 1.01-3.49) in men free of depression. Using hospitalization registry data, adjusted HRs were 2.17 (95% CI, 1.41-3.32) for MI; 3.01 (95% CI, 1.84-4.93) for stroke; and for pooled MI and stroke, the adjusted HR was 2.40 (95% CI, 1.73-3.34) in all, HR was 2.44 (95% CI, 1.05-5.55) in women, and adjusted HR was 2.27 (95% CI, 1.41-3.67) in men free of depression. World Trade Center dust exposure had no effect. CONCLUSIONS: This cohort study confirms that PTSD is a risk factor for MI and stroke of similar magnitude in men and women, independent of depression.
BACKGROUND: We sought to determine whether post-traumatic stress disorder (PTSD) is a risk factor for myocardial infarction (MI) and stroke, beyond the expected effects from recognized cardiovascular risk factors and depression. METHODS AND RESULTS: World Trade Center-Heart is an observational prospective cohort study of 6481 blue-collar first responders nested within the World Trade Center Health Program in New York City. Baseline measures in 2012 and 2013 included blood pressure, weight and height, and blood lipids. PTSD, depression, smoking, and dust exposure during the 2001 cleanup were self-reported. During the 4-year follow-up, outcomes were assessed through (1) interview-based incident, nonfatal MI, and stroke, validated in medical charts (n=118); and (2) hospitalizations for MI and stroke for New York city and state residents (n=180). Prevalence of PTSD was 19.9% in men and 25.9% in women, that is, at least twice that of the general population. Cumulative incidence of MI or stroke was consistently larger for men or women with PTSD across follow-up. Adjusted hazard ratios (HRs) were 2.22 (95% confidence interval [CI], 1.30-3.82) for MI and 2.51 (95% CI, 1.39-4.57) for stroke. For pooled MI and stroke, adjusted HRs were 2.35 (95% CI, 1.57-3.52) in all and 1.88 (95% CI, 1.01-3.49) in men free of depression. Using hospitalization registry data, adjusted HRs were 2.17 (95% CI, 1.41-3.32) for MI; 3.01 (95% CI, 1.84-4.93) for stroke; and for pooled MI and stroke, the adjusted HR was 2.40 (95% CI, 1.73-3.34) in all, HR was 2.44 (95% CI, 1.05-5.55) in women, and adjusted HR was 2.27 (95% CI, 1.41-3.67) in men free of depression. World Trade Center dust exposure had no effect. CONCLUSIONS: This cohort study confirms that PTSD is a risk factor for MI and stroke of similar magnitude in men and women, independent of depression.
Authors: Nikolaos P Daskalakis; Hagit Cohen; Caroline M Nievergelt; Dewleen G Baker; Joseph D Buxbaum; Scott J Russo; Rachel Yehuda Journal: Exp Neurol Date: 2016-07-29 Impact factor: 5.330
Authors: Dorcas J Dobie; Daniel R Kivlahan; Charles Maynard; Kristen R Bush; Tania M Davis; Katharine A Bradley Journal: Arch Intern Med Date: 2004-02-23
Authors: Robin Herbert; Jacqueline Moline; Gwen Skloot; Kristina Metzger; Sherry Baron; Benjamin Luft; Steven Markowitz; Iris Udasin; Denise Harrison; Diane Stein; Andrew Todd; Paul Enright; Jeanne Mager Stellman; Philip J Landrigan; Stephen M Levin Journal: Environ Health Perspect Date: 2006-12 Impact factor: 9.031
Authors: Matthew J Mears; David M Aslaner; Chad T Barson; Mitchell D Cohen; Matthew W Gorr; Loren E Wold Journal: Life Sci Date: 2021-11-14 Impact factor: 5.037
Authors: Tawseef Dar; Azar Radfar; Shady Abohashem; Roger K Pitman; Ahmed Tawakol; Michael T Osborne Journal: Curr Treat Options Cardiovasc Med Date: 2019-04-26
Authors: Safwan K Elkhatib; Cassandra M Moshfegh; Gabrielle F Watson; Aaron D Schwab; Kenichi Katsurada; Kaushik P Patel; Adam J Case Journal: Biol Psychiatry Glob Open Sci Date: 2021-05-25
Authors: Nancy L Sloan; Moshe Z Shapiro; Ahmad Sabra; Christopher R Dasaro; Michael A Crane; Denise J Harrison; Benjamin J Luft; Jacqueline M Moline; Iris G Udasin; Andrew C Todd; Susan L Teitelbaum Journal: Am J Ind Med Date: 2020-12-14 Impact factor: 3.079
Authors: Jennifer B Weggen; Ashley M Darling; Aaron S Autler; Austin C Hogwood; Kevin P Decker; Brandon Imthurn; Gina M Tuzzolo; Ryan S Garten Journal: Am J Physiol Regul Integr Comp Physiol Date: 2021-06-02 Impact factor: 3.210
Authors: Howard E Alper; Lisa M Gargano; James E Cone; Robert M Brackbill Journal: Int J Environ Res Public Health Date: 2020-06-13 Impact factor: 3.390