TY - JOUR
T1 - Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women
AU - Sumner, Jennifer A.
AU - Kubzansky, Laura D.
AU - Elkind, Mitchell S.V.
AU - Roberts, Andrea L.
AU - Agnew-Blais, Jessica
AU - Chen, Qixuan
AU - Cerda, Magdalena
AU - Rexrode, Kathryn M.
AU - Rich-Edwards, Janet W.
AU - Spiegelman, Donna
AU - Suglia, Shakira F.
AU - Rimm, Eric B.
AU - Koenen, Karestan C.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background - Psychological stress is a proposed risk factor for cardiovascular disease (CVD), and posttraumatic stress disorder (PTSD), the sentinel stress-related mental disorder, occurs twice as frequently in women as men. However, whether PTSD contributes to CVD risk in women is not established. Methods and Results - We examined trauma exposure and PTSD symptoms in relation to incident CVD over a 20-year period in 49 978 women in the Nurses' Health Study II. Proportional hazards models estimated hazard ratios and 95% confidence intervals for CVD events confirmed by additional information or medical record review (n=548, including myocardial infarction [n=277] and stroke [n=271]). Trauma exposure and PTSD symptoms were assessed by using the Brief Trauma Questionnaire and a PTSD screen. In comparison with no trauma exposure, endorsing ≥4 PTSD symptoms was associated with increased CVD risk after adjusting for age, family history, and childhood factors (hazard ratio,1.60; 95% confidence interval, 1.20-2.13). Being trauma-exposed and endorsing no PTSD symptoms was associated with elevated CVD risk (hazard ratio, 1.45; 95% confidence interval, 1.15-1.83), although being trauma-exposed and endorsing 1 to 3 PTSD symptoms was not. After adjusting for adult health behaviors and medical risk factors, this pattern of findings was maintained. Health behaviors and medical risk factors accounted for 14% of the trauma/no symptoms-CVD association and 47% of the trauma/4+ symptoms-CVD association. Conclusion - Trauma exposure and elevated PTSD symptoms may increase the risk of CVD in this population of women. These findings suggest that screening for CVD risk and reducing health risk behaviors in trauma-exposed women may be promising avenues for prevention and intervention.
AB - Background - Psychological stress is a proposed risk factor for cardiovascular disease (CVD), and posttraumatic stress disorder (PTSD), the sentinel stress-related mental disorder, occurs twice as frequently in women as men. However, whether PTSD contributes to CVD risk in women is not established. Methods and Results - We examined trauma exposure and PTSD symptoms in relation to incident CVD over a 20-year period in 49 978 women in the Nurses' Health Study II. Proportional hazards models estimated hazard ratios and 95% confidence intervals for CVD events confirmed by additional information or medical record review (n=548, including myocardial infarction [n=277] and stroke [n=271]). Trauma exposure and PTSD symptoms were assessed by using the Brief Trauma Questionnaire and a PTSD screen. In comparison with no trauma exposure, endorsing ≥4 PTSD symptoms was associated with increased CVD risk after adjusting for age, family history, and childhood factors (hazard ratio,1.60; 95% confidence interval, 1.20-2.13). Being trauma-exposed and endorsing no PTSD symptoms was associated with elevated CVD risk (hazard ratio, 1.45; 95% confidence interval, 1.15-1.83), although being trauma-exposed and endorsing 1 to 3 PTSD symptoms was not. After adjusting for adult health behaviors and medical risk factors, this pattern of findings was maintained. Health behaviors and medical risk factors accounted for 14% of the trauma/no symptoms-CVD association and 47% of the trauma/4+ symptoms-CVD association. Conclusion - Trauma exposure and elevated PTSD symptoms may increase the risk of CVD in this population of women. These findings suggest that screening for CVD risk and reducing health risk behaviors in trauma-exposed women may be promising avenues for prevention and intervention.
KW - cardiovascular diseases
KW - epidemiology
KW - stress disorders post-traumatic
KW - women
UR - http://www.scopus.com/inward/record.url?scp=84938634208&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84938634208&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.114.014492
DO - 10.1161/CIRCULATIONAHA.114.014492
M3 - Article
C2 - 26124186
AN - SCOPUS:84938634208
VL - 132
SP - 251
EP - 259
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 4
ER -