PTSD May Raise Risk of Heart Disease
Researchers Link Posttraumatic Stress Disorder to Calcium Buildup in Arteries
By Charlene Laino
WebMD Health News
Reviewed by Laura J. Martin, MD


Nov. 19, 2010 (Chicago) -- Posttraumatic stress disorder (PTSD) appears to be a risk factor for  atherosclerosis, a buildup of plaque in the arteries that can lead to a heart attack or stroke, preliminary research suggests.

Atherosclerosis was measured using a surrogate -- levels of calcium deposits in the arteries. And the study doesn't prove cause and effect.

Nonetheless, PTSD is emerging as an independent risk factor for heart disease, says Ramin Ebrahimi, MD, a research scientist at the Greater Los Angeles Veterans Administration Center.

In his study of nearly 300,000 veterans, those with PTSD had more than double the odds of dying than veterans without PTSD -- and greater calcium buildup in the arteries appeared to explain the difference, he says.

The findings underscore the need to screen veterans and other at-risk people for PTSD early and to follow up with aggressive evaluation and treatment as needed, Ebrahimi says.

In one in 10 Americans, a traumatic event such as combat triggers the symptoms such as intense fear, helplessness, and horror that characterize PTSD. Affected people may experience flashbacks, become emotionally detached, and be easily startled.

The new findings were presented at the annual meeting of the American Heart Association.

A Visual Guide to Heart Disease
PTSD and Calcium Buildup

The researchers combed the electronic medical records of 286,194 veterans, 85% of whom were male, treated at Veterans Administration medical centers in southern California and Nevada. Their average age was 63, and some had fought in conflicts dating back to the Korean War.

Among the 637 vets for whom coronary artery calcium CT scan images were available, those with PTSD were more likely to have calcium buildup and had more severe calcium buildup in their arteries than those without the disorder. Calcium in the coronary arteries is a sign of atherosclerosis.

More than three-fourths of vets with PTSD had some calcium buildup, compared with 59% of those without the disorder, the study shows.

The average coronary artery calcium score was 448 in the veterans with PTSD, a reading that reflects a more than 90% chance that plaque is blocking the arteries. In contrast, the average score was 332 in the veterans without PTSD -- a reading that reflects the presence of a moderate amount of plaque.

Ebrahimi says that this is the first study to make a direct association between PTSD and atherosclerosis, as measured by coronary artery calcification.
PTSD and Risk of Death

In the study, veterans with PTSD were also more likely to die from any cause than those without the disorder.

During an average follow-up of almost 10 years, 13% of the vets died. Vets with PTSD made up just over 10% of the entire group of veterans, but nearly 10% of those who died.

After taking into account risk factors for heart disease, veterans with PTSD had nearly two and one-half times the risk of death, compared with veterans without PTSD.

Among the veterans with a calcium buildup in their arteries, those with PTSD had a 48% increased risk of death from any cause and a 41% increased risk of dying from a cardiovascular disease, compared with those without the disorder.

Questions Linger About PTSD and Atherosclerosis

Former AHA President Robert Eckel, MD, professor of medicine at the University of Colorado, Denver, says the study leaves open a number of questions, most notably how PTSD might be linked to atherosclerosis.

"Is the increase in calcium due to high blood pressure, high glucose, inflammation, insulin resistance?" he asks.

Also, "chart reviews" such as this don't have enough information about patients' diets, smoking status, and exercise habits -- all factors that affect heart disease risks, Eckel tells WebMD.

"I'm not saying PTSD is not real and that it doesn't have health consequences. But much more study is needed," he says.

This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.