Skip to main content

Advertisement

SpringerLink
Log in

Posttraumatic Stress Disorder as a Risk Factor for Cardiovascular Disease: A Literature Review and Proposed Mechanisms

  • Game Changers in CV Risk Research (D Levy, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Emotional stress has long been associated with cardiovascular disease (CVD), however it is relatively recent that the evidence for a causal link has been more firmly established. While the term posttraumatic stress disorder (PTSD) has only been described since the 1970s, there is now substantial evidence, among various populations, that PTSD is associated with increased CVD risk, and that this risk is independent of other CVD risk factors. Although it is not possible to identify any one single mechanism responsible for the associations observed, it is likely that increased haemodynamic forces, inflammatory and thrombotic changes as well as elevated cholesterol levels are contributors. Despite the logistic difficulties in researching the physiological responses to PTSD, this should be a priority area for future research to guide therapies targeted at reducing CVD risk associated with this major stress disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Association, A.H. Risk Factors for Heart Disease. 2013 [cited 2013 July 29th ]; Available from: http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskofHeartAttack/Understand-Your-Risk-of-Heart-Attack_UCM_002040_Article.jsp.

  2. • Colquhoun DM, Bunker SJ, Clarke DM, et al. Screening, referral and treatment for depression in patients with coronary heart disease. Med J Aust. 2013;198(9):483–4. This position paper on cardiovascular risk factors recognised the unique and independent relationship between psychological stress and risk of hear disease.

    Article  PubMed  Google Scholar 

  3. Bunker SJ, Colquhoun DM, Esler MD. “Stress” and coronary heart disease: Psychosocial risk factors. Med J Aust. 2003;178(6):272–6.

    PubMed  Google Scholar 

  4. Stam R. PTSD and stress sensitisation: A tale of brain and body Part 1: Human studies. Neurosci Biobehav Rev. 2007;31(4):530–57.

    Article  PubMed  Google Scholar 

  5. American Psychological Association. Post-traumatic Stress Disorder. 2013 [cited 2013 August 12]; Available from: http://www.apa.org/topics/ptsd/.

  6. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.

    Article  PubMed  Google Scholar 

  7. Schonfeld WH, Verboncoeur CJ, Fifer SK, et al. The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. J Affect Disord. 1997;43(2):105–19.

    Article  PubMed  CAS  Google Scholar 

  8. Zayfert C, Dums AR, Ferguson RJ, Hegel MT. Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression. J Nerv Ment Dis. 2002;190(4):233–40.

    Article  PubMed  Google Scholar 

  9. Schnurr PP, Spiro 3rd A, Paris AH. Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans. Health Psychol. 2000;19(1):91–7.

    Article  PubMed  CAS  Google Scholar 

  10. Barrett DH, Doebbeling CC, Schwartz DA, et al. Posttraumatic stress disorder and self-reported physical health status among U.S. Military personnel serving during the Gulf War period: A population-based study. Psychosomatics. 2002;43(3):195–205.

    Article  PubMed  Google Scholar 

  11. Boscarino JA. Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Ann Epidemiol. 2006;16(4):248–56.

    Article  PubMed  Google Scholar 

  12. Kubzansky LD, Koenen KC, Spiro 3rd A, Vokonas PS, Sparrow D. Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Arch Gen Psychiatry. 2007;64(1):109–16.

    Article  PubMed  Google Scholar 

  13. Boscarino JA. A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Psychosom Med. 2008;70(6):668–76.

    Article  PubMed  Google Scholar 

  14. Richardson JD, Pekevski J, Elhai JD. Post-traumatic stress disorder and health problems among medically ill Canadian peacekeeping veterans. Aust N Z J Psychiatry. 2009;43(4):366–72.

    Article  PubMed  Google Scholar 

  15. •• Ahmadi N, Hajsadeghi F, Mirshkarlo HB, et al. Post-traumatic stress disorder, coronary atherosclerosis, and mortality. Am J Cardiol. 2011;108(1):29–33. Longitudinal cohort study of 637 veterans with mean follow-up time of 42 months following assessment of coronary calcium score (CAC). PTSD independent risk factor for development of coronary atherosclerosis. First direct link PTSD and atherosclerotic CAD as measured by CAC.

    Article  PubMed  Google Scholar 

  16. Kang HK, Bullman TA, Taylor JW. Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war. Ann Epidemiol. 2006;16(5):381–6.

    Article  PubMed  Google Scholar 

  17. Lauterbach D, Vora R, Rakow M. The relationship between posttraumatic stress disorder and self-reported health problems. Psychosom Med. 2005;67(6):939–47.

    Article  PubMed  Google Scholar 

  18. Seng JS, Clark MK, McCarthy AM, Ronis DL. PTSD and physical comorbidity among women receiving Medicaid: Results from service-use data. J Trauma Stress. 2006;19(1):45–56.

    Article  PubMed  Google Scholar 

  19. Spitzer C, Barnow S, Volzke H, et al. Trauma, posttraumatic stress disorder, and physical illness: Findings from the general population. Psychosom Med. 2009;71(9):1012–7.

    Article  PubMed  Google Scholar 

  20. Sledjeski EM, Speisman B, Dierker LC. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). J Behav Med. 2008;31(4):341–9.

    Article  PubMed  Google Scholar 

  21. Glaesmer H, Brahler E, Gundel H, Riedel-Heller SG. The association of traumatic experiences and posttraumatic stress disorder with physical morbidity in old age: a German population-based study. Psychosom Med. 2011;73(5):401–6.

    Article  PubMed  Google Scholar 

  22. Jin H, Folsom D, Sasaki A, et al. Increased Framingham 10-year risk of coronary heart disease in middle-aged and older patients with psychotic symptoms. Schizophr Res. 2011;125(2–3):295–9.

    Article  PubMed  Google Scholar 

  23. Dirkzwager AJ, van der Velden PG, Grievink L, Yzermans CJ. Disaster-related posttraumatic stress disorder and physical health. Psychosom Med. 2007;69(5):435–40.

    Article  PubMed  Google Scholar 

  24. Edmondson D, Gamboa C, Cohen A. Association of posttraumatic stress disorder and depression with all-cause and cardiovascular disease mortality and hospitalization among Hurricane Katrina survivors with end-stage renal disease. Am J Public Health. 2013;103(4):e130–7.

    Article  PubMed  Google Scholar 

  25. Holman EA, Silver RC, Poulin M, et al. Terrorism, acute stress, and cardiovascular health: A 3-year national study following the September 11th attacks. Arch Gen Psychiatry. 2008;65(1):73–80.

    Article  PubMed  Google Scholar 

  26. •• Jordan HT, Miller-Archie SA, Cone JE, Morabia A, Stellman SD, et al. Heart disease among adults exposed to the September 11, 2001 World Trade Center disaster: results from the World Trade Center Health Registry. Prev Med. 2011;53(6):370–6. Three year cohort study of 39,324 survivors enrolled in study 2 years after 2001 World trade Centre disaster. Does dependent relationship between PTSD and risk of HD observed.

    Article  PubMed  Google Scholar 

  27. Dobie DJ, Kivlahan DR, Maynard C, et al. Posttraumatic stress disorder in female veterans: Association with self-reported health problems and functional impairment. Arch Intern Med. 2004;164(4):394–400.

    Article  PubMed  Google Scholar 

  28. Zen AL, Whooley MA, Zhao S, Cohen BE. Post-traumatic stress disorder is associated with poor health behaviors: Findings from the heart and soul study. Health Psychol. 2012;31(2):194–201.

    Article  PubMed  Google Scholar 

  29. Schnurr PP, Ford JD, Friedman MJ. Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas. J Consult Clin Psychol. 2000;68(2):258–68.

    Article  PubMed  CAS  Google Scholar 

  30. Maher MJ, Rego SA, Asnis GM. Sleep disturbances in patients with post-traumatic stress disorder: Epidemiology, impact and approaches to management. CNS Drugs. 2006;20(7):567–90.

    Article  PubMed  CAS  Google Scholar 

  31. Kobayashi I, Boarts JM, Delahanty DL. Polysomnographically measured sleep abnormalities in PTSD: A meta-analytic review. Psychophysiology. 2007;44(4):660–9.

    Article  PubMed  Google Scholar 

  32. Schoenfeld FB, Deviva JC, Manber R. Treatment of sleep disturbances in posttraumatic stress disorder: A review. J Rehabil Res Dev. 2012;49(5):729–52.

    Article  PubMed  Google Scholar 

  33. Vanitallie TB. Stress: A risk factor for serious illness. Metabolism. 2002;51(6 Suppl 1):40–5.

    Article  PubMed  CAS  Google Scholar 

  34. Glover DA, Poland RE. Urinary cortisol and catecholamines in mothers of child cancer survivors with and without PTSD. Psychoneuroendocrinology. 2002;27(7):805–19.

    Article  PubMed  CAS  Google Scholar 

  35. Meewisse ML, Reitsma JB, Vries GJ, et al. Cortisol and post-traumatic stress disorder in adults: systematic review and meta-analysis. Br J Psychiatry. 2007;191:387–92.

    Article  PubMed  Google Scholar 

  36. Delahanty DL, Nugent NR, Christopher NC, Walsh M, et al. Initial urinary epinephrine and cortisol levels predict acute PTSD symptoms in child trauma victims. Psychoneuroendocrinology. 2005;30(2):121–8.

    Article  PubMed  CAS  Google Scholar 

  37. de Quervain DJ. Glucocorticoid-induced reduction of traumatic memories: implications for the treatment of PTSD. Prog Brain Res. 2008;167:239–47.

    Article  PubMed  Google Scholar 

  38. Koertge J, Al-Khalili F, Ahnve S. Cortisol and vital exhaustion in relation to significant coronary artery stenosis in middle-aged women with acute coronary syndrome. Psychoneuroendocrinology. 2002;27(8):893–906.

    Article  PubMed  CAS  Google Scholar 

  39. Cohen H, Benjamin J, Geva AB. Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks. Psychiatry Res. 2000;96(1):1–13.

    Article  PubMed  CAS  Google Scholar 

  40. Wahbeh H, Oken BS. Peak high-frequency HRV and peak alpha frequency higher in PTSD. Appl Psychophysiol Biofeedback. 2013;38(1):57–69.

    Article  PubMed  Google Scholar 

  41. Tan G, Dao TK, Farmer L, Sutherland RJ, Gevirtz R. Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study. Appl Psychophysiol Biofeedback. 2011;36(1):27–35.

    Article  PubMed  Google Scholar 

  42. Thayer JF, Lane RD. The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psychol. 2007;74(2):224–42.

    Article  PubMed  Google Scholar 

  43. Buckley TC, Holohan D, Greif JL, Bedard M, Suvak M. Twenty-four-hour ambulatory assessment of heart rate and blood pressure in chronic PTSD and non-PTSD veterans. J Trauma Stress. 2004;17(2):163–71.

    Article  PubMed  Google Scholar 

  44. Beckham JC, Vrana SR, Barefoot JC, et al. Magnitude and duration of cardiovascular responses to anger in Vietnam veterans with and without posttraumatic stress disorder. J Consult Clin Psychol. 2002;70(1):228–34.

    Article  PubMed  Google Scholar 

  45. Forneris CA, Butterfield MI, Bosworth HB. Physiological arousal among women veterans with and without posttraumatic stress disorder. Mil Med. 2004;169(4):307–12.

    PubMed  Google Scholar 

  46. Bedi US, Arora R. Cardiovascular manifestations of posttraumatic stress disorder. J Natl Med Assoc. 2007;99(6):642–9.

    PubMed  Google Scholar 

  47. Cohen BE, Marmar C, Ren L, Bertenthal D, Seal KH. Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan war veterans using VA health care. JAMA. 2009;302(5):489–92.

    Article  PubMed  CAS  Google Scholar 

  48. Kleim B, Wilhelm FH, Glucksman E, Ehlers A. Sex differences in heart rate responses to script-driven imagery soon after trauma and risk of posttraumatic stress disorder. Psychosom Med. 2010;72(9):917–24.

    Article  PubMed  Google Scholar 

  49. Buckley T, Stannard A, Bartrop R, et al. Early bereavement is associated with increased heart rate and reduced heart rate variability. Circulation. 2010;122:A14660.

    Google Scholar 

  50. Heidland UE, Strauer BE. Left ventricular muscle mass and elevated heart rate are associated with coronary plaque disruption. Circulation. 2001;104(13):1477–82.

    Article  PubMed  CAS  Google Scholar 

  51. Reist C, Duffy JG, Fujimoto K, Cahill L. Beta-Adrenergic blockade and emotional memory in PTSD. Int J Neuropsychopharmacol. 2001;4(4):377–83.

    Article  PubMed  CAS  Google Scholar 

  52. Donovan E. Propranolol use in the prevention and treatment of posttraumatic stress disorder in military veterans: Forgetting therapy revisited. Perspect Biol Med. 2010;53(1):61–74.

    Article  PubMed  Google Scholar 

  53. Lindgren ME, Fagundes CP, Alfano CM, et al. Beta-blockers may reduce intrusive thoughts in newly diagnosed cancer patients. Psychooncology. 2013;22(8):1889–94.

    Article  PubMed  Google Scholar 

  54. Pitman RK, Sanders KM, Zusman RM. Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry. 2002;51(2):189–92.

    Article  PubMed  CAS  Google Scholar 

  55. O'Toole BI, Catts SV. Trauma, PTSD, and physical health: An epidemiological study of Australian Vietnam veterans. J Psychosom Res. 2008;64(1):33–40.

    Article  PubMed  Google Scholar 

  56. Maes M, Lin AH, Delmeire L, et al. Elevated serum interleukin-6 (IL-6) and IL-6 receptor concentrations in posttraumatic stress disorder following accidental man-made traumatic events. Biol Psychiatry. 1999;45(7):833–9.

    Article  PubMed  CAS  Google Scholar 

  57. Boscarino JA. Posttraumatic stress disorder and physical illness: Results from clinical and epidemiologic studies. Ann N Y Acad Sci. 2004;1032:141–53.

    Article  PubMed  Google Scholar 

  58. von Kanel R, Begre S, Abbas CC, et al. Inflammatory biomarkers in patients with posttraumatic stress disorder caused by myocardial infarction and the role of depressive symptoms. Neuroimmunomodulation. 2010;17(1):39–46.

    Article  Google Scholar 

  59. Ridker PM, Cushman M, Stampfer MJ. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336(14):973–9.

    Article  PubMed  CAS  Google Scholar 

  60. von Kanel R, Hepp U, Buddeberg C. Altered blood coagulation in patients with posttraumatic stress disorder. Psychosom Med. 2006;68(4):598–604.

    Article  Google Scholar 

  61. Solter V, Thaller V, Karlovic D, Crnkovic D. Elevated serum lipids in veterans with combat-related chronic posttraumatic stress disorder. Croat Med J. 2002;43(6):685–9.

    PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Thomas Buckley, Geoffrey Tofler and Holly G. Prigerson declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Cardiology, Faculty of Nursing, The University of Sydney, Royal North Shore Hospital, Sydney, Australia

    Thomas Buckley

  2. Department of Cardiology, Sydney Medical School, Royal North Shore Hospital, Sydney, Australia

    Geoffrey Tofler

  3. Center for Psychosocial Epidemiology and Outcomes Research, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA

    Holly G. Prigerson

Authors
  1. Thomas Buckley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Geoffrey Tofler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Holly G. Prigerson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Buckley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buckley, T., Tofler, G. & Prigerson, H.G. Posttraumatic Stress Disorder as a Risk Factor for Cardiovascular Disease: A Literature Review and Proposed Mechanisms. Curr Cardiovasc Risk Rep 7, 506–513 (2013). https://doi.org/10.1007/s12170-013-0348-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12170-013-0348-3

Keywords

Search

Navigation