TY - JOUR
T1 - Posttraumatic stress disorder and risk for coronary heart disease
T2 - A meta-analytic review
AU - Edmondson, Donald
AU - Kronish, Ian M.
AU - Shaffer, Jonathan A.
AU - Falzon, Louise
AU - Burg, Matthew M.
N1 - Funding Information:
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following: all authors had financial support from the National Institutes of Health for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work. Author contributions: Dr Edmondson conceived the study, led the writing, and is responsible for the statistical analyses. Drs Kronish and Dr Shaffer assisted with analyses and wrote portions of the manuscript. Ms Falzon served as information specialist and created and performed the literature search. Dr Burg served as senior author, abstracted the study data, and was involved with all aspects of manuscript preparation. Permissions: The corresponding author has the right to grant, on behalf of all authors, and does grant, on behalf of all authors, an exclusive license (or nonexclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd and its licensees to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and sublicenses to exploit all subsidiary rights.
PY - 2013/11
Y1 - 2013/11
N2 - Objective The aim of this study was to estimate the association of posttraumatic stress disorder (PTSD) with risk for incident coronary heart disease (CHD). Design A systematic review and meta-analysis were used as study designs. Data Sources Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and PubMed Related Articles and through a manual search of reference lists (1948-present). Study Selection All studies that assessed PTSD in participants initially free of CHD and subsequently assessed CHD/cardiac-specific mortality were included. Data Extraction Two investigators independently extracted estimates of the association of PTSD with CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HRs), and a random-effects model was used to pool results. A secondary analysis including only studies that reported estimates adjusted for depression was conducted. Results Six studies met our inclusion criteria (N = 402,274); 5 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.55 (95% CI 1.34-1.79) before adjustment for depression. The pooled HR estimate for the 5 depression-adjusted estimates (N = 362,950) was 1.27 (95% CI 1.08-1.49). Conclusion Posttraumatic stress disorder is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. It is common in both military veterans and civilian trauma survivors, and these results suggest that it may be a modifiable risk factor for CHD. Future research should identify the mechanisms of this association and determine whether PTSD treatment offsets CHD risk.
AB - Objective The aim of this study was to estimate the association of posttraumatic stress disorder (PTSD) with risk for incident coronary heart disease (CHD). Design A systematic review and meta-analysis were used as study designs. Data Sources Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and PubMed Related Articles and through a manual search of reference lists (1948-present). Study Selection All studies that assessed PTSD in participants initially free of CHD and subsequently assessed CHD/cardiac-specific mortality were included. Data Extraction Two investigators independently extracted estimates of the association of PTSD with CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HRs), and a random-effects model was used to pool results. A secondary analysis including only studies that reported estimates adjusted for depression was conducted. Results Six studies met our inclusion criteria (N = 402,274); 5 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.55 (95% CI 1.34-1.79) before adjustment for depression. The pooled HR estimate for the 5 depression-adjusted estimates (N = 362,950) was 1.27 (95% CI 1.08-1.49). Conclusion Posttraumatic stress disorder is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. It is common in both military veterans and civilian trauma survivors, and these results suggest that it may be a modifiable risk factor for CHD. Future research should identify the mechanisms of this association and determine whether PTSD treatment offsets CHD risk.
UR - https://www.scopus.com/pages/publications/84886947053
U2 - 10.1016/j.ahj.2013.07.031
DO - 10.1016/j.ahj.2013.07.031
M3 - Review article
C2 - 24176435
AN - SCOPUS:84886947053
SN - 0002-8703
VL - 166
SP - 806
EP - 814
JO - American Heart Journal
JF - American Heart Journal
IS - 5
ER -