Jeffrey F Scherrer1, Joanne Salas2, F David Schneider3, Matthew J Friedman4, Carissa van den Berk-Clark5, Kathleen M Chard6, Sonya B Norman7, Patrick J Lustman8, Peter Tuerk9, Paula P Schnurr4, Beth E Cohen10. 1. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States of America; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States of America. Electronic address: jeffrey.scherrer@health.slu.edu. 2. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States of America; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States of America. 3. Department of Family and Community Medicine, University of Texas Southwestern, Dallas, TX, United States of America. 4. National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America. 5. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States of America. 6. Trauma Recovery Center Cincinnati VAMC and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, OH, United States of America. 7. National Center for PTSD and Department of Psychiatry, University of California San Diego, United States of America. 8. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States of America; The Bell Street Clinic Opioid Addiction Treatment Program, VA St. Louis Health Care System, St. Louis, MO, United States of America. 9. Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, VA, United States of America. 10. Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, CA, United States of America.
Abstract
BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiovascular disease (CVD). Whether clinically meaningful PTSD improvement is associated with lowering CVD risk is unknown. METHODS: Eligible patients (n = 1079), were 30-70 years old, diagnosed with PTSD and used Veterans Health Affairs PTSD specialty clinics. Patients had a PTSD Checklist score (PCL) ≥ 50 between Fiscal Year (FY) 2008 and FY2012 and a second PCL score within 12 months and at least 8 weeks after the first PCL ≥ 50. Clinically meaningful PTSD improvement was defined by ≥20 point PCL decrease between the first and second PCL score. Patients were free of CVD diagnoses for 1 year prior to index. Index date was 12 months following the first PCL. Follow-up continued to FY2015. Cox proportional hazard models estimated the association between clinically meaningful PTSD improvement and incident CVD and incident ischemic heart disease (IHD). Sensitivity analysis stratified by age group (30-49 vs. 50-70 years) and depression. Confounding was controlled using propensity scores and inverse probability of exposure weighting. RESULTS: Patients were 48.9 ± 10.9 years of age on average, 83.3% male, 60.1% white, and 29.5% black. After controlling for confounding, patients with vs. without PTSD improvement did not differ in CVD risk (HR = 1.08; 95%CI: 0.72-1.63). Results did not change after stratifying by age group or depression status. Results were similar for incident IHD. CONCLUSIONS: Over a 2-7 year follow-up, we did not find an association between clinically meaningful PTSD improvement and incident CVD. Additional research is needed using longer follow-up.
BACKGROUND:Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiovascular disease (CVD). Whether clinically meaningful PTSD improvement is associated with lowering CVD risk is unknown. METHODS: Eligible patients (n = 1079), were 30-70 years old, diagnosed with PTSD and used Veterans Health Affairs PTSD specialty clinics. Patients had a PTSD Checklist score (PCL) ≥ 50 between Fiscal Year (FY) 2008 and FY2012 and a second PCL score within 12 months and at least 8 weeks after the first PCL ≥ 50. Clinically meaningful PTSD improvement was defined by ≥20 point PCL decrease between the first and second PCL score. Patients were free of CVD diagnoses for 1 year prior to index. Index date was 12 months following the first PCL. Follow-up continued to FY2015. Cox proportional hazard models estimated the association between clinically meaningful PTSD improvement and incident CVD and incident ischemic heart disease (IHD). Sensitivity analysis stratified by age group (30-49 vs. 50-70 years) and depression. Confounding was controlled using propensity scores and inverse probability of exposure weighting. RESULTS:Patients were 48.9 ± 10.9 years of age on average, 83.3% male, 60.1% white, and 29.5% black. After controlling for confounding, patients with vs. without PTSD improvement did not differ in CVD risk (HR = 1.08; 95%CI: 0.72-1.63). Results did not change after stratifying by age group or depression status. Results were similar for incident IHD. CONCLUSIONS: Over a 2-7 year follow-up, we did not find an association between clinically meaningful PTSD improvement and incident CVD. Additional research is needed using longer follow-up.
Authors: K C Koenen; J A Sumner; P Gilsanz; M M Glymour; A Ratanatharathorn; E B Rimm; A L Roberts; A Winning; L D Kubzansky Journal: Psychol Med Date: 2016-10-04 Impact factor: 7.723
Authors: Viola Vaccarino; Jack Goldberg; Cherie Rooks; Amit J Shah; Emir Veledar; Tracy L Faber; John R Votaw; Christopher W Forsberg; J Douglas Bremner Journal: J Am Coll Cardiol Date: 2013-06-27 Impact factor: 24.094
Authors: Patricia A Resick; Jennifer Schuster Wachen; Katherine A Dondanville; Kristi E Pruiksma; Jeffrey S Yarvis; Alan L Peterson; Jim Mintz; Elisa V Borah; Antoinette Brundige; Elizabeth A Hembree; Brett T Litz; John D Roache; Stacey Young-McCaughan Journal: JAMA Psychiatry Date: 2017-01-01 Impact factor: 21.596