PTSD improvement and incident cardiovascular disease in more than 1000 veterans.
Cardiovascular disease
Epidemiology
Posttraumatic stress disorder
Psychotherapy
Veterans
Journal
Journal of psychosomatic research
ISSN: 1879-1360
Titre abrégé: J Psychosom Res
Pays: England
ID NLM: 0376333
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
10
02
2020
revised:
28
04
2020
accepted:
02
05
2020
pubmed:
14
5
2020
medline:
28
11
2020
entrez:
14
5
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32403058
pii: S0022-3999(20)30133-1
doi: 10.1016/j.jpsychores.2020.110128
pmc: PMC7274904
mid: NIHMS1592918
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
110128Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL125424
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None.
Références
J Trauma Stress. 2009 Jun;22(3):197-204
pubmed: 19466746
JAMA Psychiatry. 2017 Jan 1;74(1):28-36
pubmed: 27893032
Annu Rev Clin Psychol. 2013;9:327-54
pubmed: 23537487
J Clin Psychiatry. 2000;61 Suppl 7:22-32
pubmed: 10795606
Behav Res Ther. 1996 Aug;34(8):669-73
pubmed: 8870294
Psychol Med. 2017 Jan;47(2):209-225
pubmed: 27697083
Stat Med. 2015 Dec 10;34(28):3661-79
pubmed: 26238958
Psychosom Med. 2008 Jul;70(6):668-76
pubmed: 18596248
J Rehabil Res Dev. 2011;48(1):21-30
pubmed: 21328160
J Am Coll Cardiol. 2013 Sep 10;62(11):970-8
pubmed: 23810885
Am J Cardiol. 2011 Oct 1;108(7):1052-3
pubmed: 21920186
Health Psychol. 2009 Jan;28(1):125-30
pubmed: 19210026
J Intern Med. 2014 Jun;275(6):570-80
pubmed: 24520806
Arch Gen Psychiatry. 2007 Jan;64(1):109-16
pubmed: 17199060
Psychol Med. 2017 Jun;47(8):1370-1378
pubmed: 28052776
Med Care. 2007 Oct;45(10 Supl 2):S103-7
pubmed: 17909367
Am J Epidemiol. 2008 Sep 15;168(6):656-64
pubmed: 18682488
J Consult Clin Psychol. 2014 Aug;82(4):569-579
pubmed: 24731235
Depress Anxiety. 2009;26(8):732-8
pubmed: 18781660
Psychosom Med. 2017 Feb/Mar;79(2):181-188
pubmed: 27490852
J Am Heart Assoc. 2019 Feb 19;8(4):e011133
pubmed: 30755078
J Consult Clin Psychol. 2012 Apr;80(2):201-10
pubmed: 22182261
Psychol Assess. 2008 Jun;20(2):131-8
pubmed: 18557690
JAMA Psychiatry. 2019 Aug 21;:
pubmed: 31433443
Curr Hypertens Rep. 2010 Feb;12(1):10-6
pubmed: 20425153
Prog Cardiovasc Dis. 2013 May-Jun;55(6):548-56
pubmed: 23621964
JAMA. 1971 May 17;216(7):1185-7
pubmed: 5108403
Psychosom Med. 2011 Oct;73(8):697-707
pubmed: 21949429
Circulation. 2015 Jul 28;132(4):251-9
pubmed: 26124186