Hostname: page-component-745bb68f8f-f46jp Total loading time: 0 Render date: 2025-02-05T09:43:31.320Z Has data issue: false hasContentIssue false
  • English
  • Français

Post-traumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women

Published online by Cambridge University Press:  05 January 2017

P. Gilsanz ,
A. Winning ,
K. C. Koenen ,
A. L. Roberts ,
J. A. Sumner ,
Q. Chen ,
M. M. Glymour ,
E. B. Rimm  and
L. D. Kubzansky
P. Gilsanz*
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
A. Winning
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
K. C. Koenen
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
A. L. Roberts
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
J. A. Sumner
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
Q. Chen
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
M. M. Glymour
Affiliation:
Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA
E. B. Rimm
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital,Boston, MA, USA
L. D. Kubzansky
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
*
*Address for correspondence: P. Gilsanz, Sc.D., Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Boston, MA 02115, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Prior studies suggest that post-traumatic stress disorder (PTSD) is associated with elevated cardiovascular disease (CVD) risk, but effects of duration and remission of PTSD symptoms have rarely been evaluated.

Method

We examined the association of time-updated PTSD symptom severity, remission and duration with incident CVD risk (552 confirmed myocardial infarctions or strokes) over 20 years in 49 859 women in the Nurses’ Health Study II. Among women who reported trauma on the Brief Trauma Questionnaire, PTSD symptoms, assessed by a screener, were classified by symptom severity and chronicity: (a) no symptoms, (b) 1–3 ongoing, (c) 4–5 ongoing, (d) 6–7 ongoing, (e) 1–3 remitted, (f) 4–7 remitted symptoms. Inverse probability weighting was used to estimate marginal structural logistic regression models, adjusting for time-varying and time-invariant confounders.

Results

Compared with women with no trauma exposure, women with trauma/no PTSD [odds ratio (OR) 1.30, 95% confidence interval (CI) 1.03–1.65] and women with trauma/6–7 symptoms (OR 1.69, 95% CI 1.08–2.63) had elevated risk of CVD; women with remitted symptoms did not have elevated CVD risk. Among women exposed to trauma, every 5 additional years of PTSD symptomology was associated with 9% higher CVD incidence compared with women with trauma/no PTSD.

Conclusions

The findings suggest that alleviating PTSD symptoms shortly after onset may attenuate CVD risk.

Keywords

Durationmarginal structural modelspost-traumatic stress disorderremissionseverity
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 8 , June 2017 , pp. 1370 - 1378
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adebamowo, SN, Spiegelman, D, Willett, WC, Rexrode, KM (2015). Association between intakes of magnesium, potassium, and calcium and risk of stroke: 2 cohorts of US women and updated meta-analyses. American Journal of Clinical Nutrition 101, 1269–1277.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Beristianos, MH, Yaffe, K, Cohen, B, Byers, AL (2016). PTSD and risk of incident cardiovascular disease in aging veterans. American Journal of Geriatric Psychiatry 24, 192–200.Google Scholar
Boscarino, JA (2011). Post-traumatic stress disorder and cardiovascular disease link: time to identify specific pathways and interventions. American Journal of Cardiology 108, 1052–1053.Google Scholar
Breslau, N, Peterson, E, Kessler, R, Schultz, L (1999). Short screening scale for DSM-IV posttraumatic stress disorder. American Journal of Psychiatry 156, 908–911.CrossRefGoogle ScholarPubMed
Brewin, C, Andrews, B, Valentine, J (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 317–336.CrossRefGoogle ScholarPubMed
Brown, PJ, Wolfe, J (1994). Substance abuse and post-traumatic stress disorder comorbidity. Drug and Alcohol Dependence 35, 51–59.Google Scholar
Burns, DM (2003). Epidemiology of smoking-induced cardiovascular disease. Progress in Cardiovascular Diseases 46, 11–29.CrossRefGoogle ScholarPubMed
Chiuve, SE, Fung, TT, Rimm, EB, Hu, FB, McCullough, ML, Wang, M, Stampfer, MJ, Willett, WC (2012). Alternative dietary indices both strongly predict risk of chronic disease. Journal of Nutrition 142, 1009–1018.Google Scholar
Coughlin, SS (2011). Post-traumatic stress disorder and cardiovascular disease. Open Cardiovascular Medicine Journal 5, 164–170.Google Scholar
D'Agostino, RB, Lee, ML, Belanger, AJ, Cupples, LA, Anderson, K, Kannel, WB (1990). Relation of pooled logistic regression to time dependent Cox regression analysis: the Framingham Heart Study. Statistics in Medicine 9, 1501–1515.CrossRefGoogle ScholarPubMed
D'Andrea, W, Sharma, R, Zelechoski, AD, Spinazzola, J (2011). Physical health problems after single trauma exposure: when stress takes root in the body. Journal of the American Psychiatric Nurses Association 17, 378–392.Google Scholar
Edmondson, D, Cohen, BE (2013). Posttraumatic stress disorder and cardiovascular disease. Progress in Cardiovascular Diseases 55, 548–556.Google Scholar
Edmondson, D, Kronish, IM, Shaffer, JA, Falzon, L, Burg, MM (2013). Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. American Heart Journal 166, 806–814.Google Scholar
Ferraro, P, Taylor, EN, Eisner, BH, Gambaro, G, Rimm, EB, Mukamal, KJ, Curhan, GC (2013). History of kidney stones and the risk of coronary heart disease. Journal of the American Medical Association 310, 408–415.Google Scholar
Fu, SS, Mcfall, M, Saxon, AJ, Beckham, JC, Carmody, TP, Baker, DG, Joseph, AM (2007). Post-traumatic stress disorder and smoking: a systematic review. Nicotine and Tobacco Research 9, 1071–1084.Google Scholar
Graham-Garcia, J, Raines, TL, Andrews, JO, Mensah, GA (2001). Race, ethnicity, and geography: disparities in heart disease in women of color. Journal of Transcultural Nursing 12, 56–67.CrossRefGoogle ScholarPubMed
Hall, KS, Hoerster, KD, Yancy, WS (2015). Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiologic Reviews 37, 103–115.Google Scholar
Hernán, MA, Brumback, B, Robins, JM (2000). Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men. Epidemiology 11, 561–570.Google Scholar
Koenen, K, De Vivo, I, Rich-Edwards, J, Smoller, J, Wright, R, Purcell, S (2009). Protocol for investigating genetic determinants of posttraumatic stress disorder in women from the Nurses’ Health Study II. BMC Psychiatry 9, 29.Google Scholar
Koenen, K, Moffitt, T, Poulton, R, Martin, J, Caspi, A (2007). Early childhood factors associated with posttraumatic stress disorder: results from a longitudinal birth cohort. Psychological Medicine 37, 181–192.Google Scholar
Kubzansky, LD, Bordelois, P, Jun, H, Roberts, AL, Cerda, M, Bluestone, N, Koenen, KC (2014). The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry 71, 44–51.Google Scholar
Kubzansky, LD, Koenen, KC, Jones, C, Eaton, WW (2009). A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women. Health Psychology 28, 125–130.CrossRefGoogle ScholarPubMed
Kubzansky, LD, Koenen, KC, Spiro, A III, Vokonas, PS, Sparrow, D (2007). Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Archives of General Psychiatry 64, 109–116.Google Scholar
Lee, YC, Agnew-Blais, J, Malspeis, S, Keyes, K, Costenbader, K, Kubzansky, LD, Roberts, AL, Koenen, KC, Karlson, EW (2016). Post-traumatic stress disorder and risk for incident rheumatoid arthritis. Arthritis Care and Research 68, 292–298.Google Scholar
Levine, AB, Levine, LM, Levine, TB (2014). Posttraumatic stress disorder and cardiometabolic disease. Cardiology 127, 1–19.Google Scholar
Lowe, SR, Galea, S, Uddin, M, Koenen, KC (2014). Trajectories of posttraumatic stress among urban residents. American Journal of Community Psychology 53, 159–172.Google Scholar
Morina, N, Wicherts, JM, Lobbrecht, J, Priebe, S (2014). Remission from post-traumatic stress disorder in adults: a systematic review and meta-analysis of long term outcome studies. Clinical Psychology Review 34, 249–255.Google Scholar
Nandi, A, Glymour, MM, Kawachi, I, Vanderweele, TJ (2012). Using marginal structural models to estimate the direct effect of adverse childhood social conditions on onset of heart disease, diabetes, and stroke. Epidemiology 23, 223–232.Google Scholar
O'Toole, BI, Catts, SV (2008). Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. Journal of Psychosomatic Research 64, 33–40.CrossRefGoogle ScholarPubMed
Robins, JM (1999). Association, causation, and marginal structural models. Synthese 121, 151–179.Google Scholar
Robins, JM, Hernán, MÁ, Brumback, B (2000). Marginal structural models and causal inference in epidemiology. Epidemiology 11, 550–560.Google Scholar
Rose, G, Blackburn, H (2002). Cardiovascular Survey Methods. World Health Organization: Geneva.Google Scholar
Scherrer, JF, Chrusciel, T, Zeringue, A, Garfield, LD, Hauptman, PJ, Lustman, PJ, Freedland, KE, Carney, RM, Bucholz, KK, Owen, R (2010). Anxiety disorders increase risk for incident myocardial infarction in depressed and nondepressed Veterans Administration patients. American Heart Journal 159, 772–779.Google Scholar
Shah, AJ, Lampert, R, Goldberg, J, Veledar, E, Bremner, JD, Vaccarino, V (2013). Posttraumatic stress disorder and impaired autonomic modulation in male twins. Biological Psychiatry 73, 1103–1110.Google Scholar
Sumner, JA, Kubzansky, LD, Elkind, MSV, Roberts, AL, Agnew-Blais, J, Chen, Q, Cerdá, M, Rexrode, KM, Rich-Edwards, JW, Spiegelman, D, Suglia, SF, Rimm, EB, Koenen, KC (2015). Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation 132, 251–259.Google Scholar
Tchetgen Tchetgen, EJ, Glymour, MM, Weuve, J, Robins, J (2012) Specifying the correlation structure in inverse-probability-weighting estimation for repeated measures. Epidemiology 23, 644–646.CrossRefGoogle ScholarPubMed
Turner, JH, Neylan, TC, Schiller, NB, Li, Y, Cohen, BE (2013). Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder. Biological Psychiatry 74, 861–866.Google Scholar
US Department of Health and Human Services (1990). The Health Benefits of Smoking Cessation: a Report of the Surgeon General. Public Health Service, Office on Smoking and Health: Rockville, MD.Google Scholar
Van Der Velden, PG, Kleber, RJ, Koenen, KC (2008). Smoking predicts posttraumatic stress symptoms among rescue workers: a prospective study of ambulance personnel involved in the Enschede Fireworks Disaster. Drug and Alcohol Dependence 94, 267–271.CrossRefGoogle ScholarPubMed
Walker, AE, Robins, M, Weinfeld, FD (1981). The National Survey of Stroke. Clinical findings. Stroke 12, I13–I44.Google Scholar
Yehuda, R, Ledoux, J (2007). Response variation following trauma: a translational neuroscience approach to understanding PTSD. Neuron 56, 19–32.CrossRefGoogle ScholarPubMed
Zen, AL, Zhao, S, Whooley, MA, Cohen, BE (2012). Post-traumatic stress disorder is associated with poor health behaviors: findings from the Heart and Soul Study. Health Psychology 31, 194–201.CrossRefGoogle ScholarPubMed
Supplementary material: File

Gilsanz supplementary material

Tables S1-S4

Download Gilsanz supplementary material(File)
File 121.3 KB