Objectives: The aim of this study was to determine whether post-traumatic stress disorder (PTSD) is associated with coronary heart disease (CHD) using a prospective twin study design and objective measures of CHD.
Background: It has long been hypothesized that PTSD increases the risk of CHD, but empirical evidence using objective measures is limited.
Methods: We conducted a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Among twin pairs without self-reported CHD at baseline, we selected pairs discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition. All underwent a clinic visit after a median follow-up of 13 years. Outcomes included clinical events (myocardial infarction, other hospitalizations for CHD and coronary revascularization) and quantitative measures of myocardial perfusion by [(13)N] ammonia positron emission tomography, including a stress total severity score and coronary flow reserve.
Results: A total of 562 twins (281 pairs) with a mean age of 42.6 years at baseline were included in this study. The incidence of CHD was more than double in twins with PTSD (22.6%) than in those without PTSD (8.9%; p < 0.001). The association remained robust after adjusting for lifestyle factors, other risk factors for CHD, and major depression (odds ratio: 2.2; 95% confidence interval: 1.2 to 4.1). Stress total severity score was significantly higher (+95%, p = 0.001) and coronary flow reserve was lower (-0.21, p = 0.02) in twins with PTSD than in those without PTSD, denoting worse myocardial perfusion. Associations were only mildly attenuated in 117 twin pairs discordant for PTSD.
Conclusions: Among Vietnam-era veterans, PTSD is a risk factor for CHD.
Keywords: CFR; CHD; CI; DIS; DSM-III-R; Diagnostic Interview Schedule; Diagnostic and Statistical Manual of Mental Disorders-Third Edition-Revised; OR; PET; PTSD; STSS; cardiovascular diseases; confidence interval; coronary flow reserve; coronary heart disease; epidemiology; odds ratio; positron emission tomography; post-traumatic stress disorder; risk factors; stress; stress total severity score.
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.