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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])
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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 

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