, Volume 21, Issue 3, pp 227-234

Electrocardiogram abnormalities among men with stress-related psychiatric disorders: Implications for coronary heart disease and clinical research

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Research suggests psychological distress could result in arterial endothelial injury and coronary heart diseae (CHD). Studies also show Posttraumatic Stress Disorder (PTSD) victims have higher circulating catecholamines and other sympathoadrenal-neuroendocrine bioactive agents implicated in arterial damage. Here we analyzed resting 12-lead electrocardiographic (ECG) results among a national sample of 4,462 nonhospitalized male veterans (mean age=38) about 20 years after military service by current posttraumatic stress (n=54), general anxiety (n=186), and depression (n=157) disorders. ECGs were interpreted by board-certified cardiologists and summarized using theMinnesota Code Manual of Electrocardiographic Findings. Psychiatric disorders were diagnosed based on theDiagnostic Interview Schedule, Version III. Controlling for age, place of service, illicit drug use, medication use, race, body mass index, alcohol use, cigarette smoking, and education, PTSD (odds ratio [OR]=2.23, 95% confidence interval [CI]=1.17–4.26,p<0.05), anxiety (OR=1.51, 95% CI=1.03−2.22,p<0.05), and depression (OR=1.71, 95% CI=1.13−2.58,p<0.01) were associated with having a positive ECG finding. Specific results indicate PTSD was associated with atrioventricular (AV) conduction defects (OR=2.81, 95% CI=1.03−7.66,p<0.05) and infarctions (OR=4.44, 95% CI=1.20−16.43,p<0.05), while depression was associated with arrhythmias (OR=1.98, 95% CI=1.22−3.23,p<0.01). The PTSD associations for AV conduction defects and infarctions held, even after controlling for current anxiety and depression. These findings suggest psychological distress may result in CHD, because we controlled for obvious biases and confounders, the men studied had current PTSD due to combat exposures 20 years ago, combat exposure was associated with anxiety and depression among these men, and the men were disease free at military induction. These findings suggest the need for clinical surveillance among combat veterans, better psychobiologic models of CHD pathogenesis, and additional research.

Catholic Health Initiatives
Preparation of this manuscript was supported in part by the National Institute of Mental Health Grant #MH-19105 and the Sisters of Charity of Nazareth Health System, Louisville, KY.
The first author wishes to express appreciation to the Centers for Disease Control, Atlanta, Georgia, for making this study possible and for their assistance.
A version of this paper was presented at the 18th Annual Meeting of the Society of Behavioral Medicine, San Francisco, CA, April 1997.