Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the normative aging study

Context: Various correlates of posttraumatic stress disorder ( PTSD), such as high levels of sympathetic activation and hypothalamic-pituitary-adrenal axis dysregulation, have been linked to arterial damage and coronary heart disease ( CHD) risk. While psychological disturbance is frequently found among patients with cardiac disease, whether psychological problems precede or occur as a result of having a potentially fatal disease is not clear. To our knowledge, no prospective studies to date have evaluated whether PTSD is associated with increased risk of CHD. Objective: To test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using 2 different measures of PTSD. Design: Prospective cohort study. Setting: Community-dwelling men from the Greater Boston, Mass, area who served in the military. Participants: Data are from the Veterans Affairs Normative Aging Study. Men who completed either the Mississippi Scale for Combat-Related PTSD in 1990 ( n = 1002) or the Keane PTSD scale in 1986 ( n = 944) were included in the study. Main Outcome Measure: Incident CHD occurring during follow-up through May 2001. Results: Levels of PTSD symptoms in this cohort were low to moderate. Men with preexisting CHD at baseline were excluded, and PTSD was measured with the Mississippi Scale for Combat-Related PTSD. For each SD increase in symptom level, men had age-adjusted relative risks of 1.26 ( 95% confidence interval, 1.05-1.51) for non-fatal myocardial infarction and fatal CHD combined and 1.21 ( 95% confidence interval, 1.05-1.41) for all of the CHD outcomes combined ( nonfatal myocardial infarction, fatal CHD, and angina). Findings were replicated using the Keane PTSD scale and somewhat strengthened after controlling for levels of depressive symptoms. Conclusions: To our knowledge, this is the first study to demonstrate a prospective association between PTSD symptoms and CHD even after controlling for depressive symptoms. These results suggest that a higher level of PTSD symptoms may increase the risk of incident-CHD in older men.