Electrocardiogram abnormalities among men with stress-related psychiatric disorders: Implications for coronary heart disease and clinical research
Abstract
Research suggests psychological distress could result in arterial endothelial injury and coronary heart disease (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 the Minnesota Code Manual of Electrocardiographic Findings. Psychiatric disorders were diagnosed based on the Diagnostic 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 a military induction. These findings suggest the need for clinical surveillance among combat veterans, better psychobiologic models of CHD pathogenesis, and additional research.
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A proinflammatory state may serve as an underlying biological mechanism by which PTSD and other fear- and anxiety-based disorders are highly co-morbid with CVD and metabolic syndrome, as well as other physical illnesses.
“A proinflammatory state may serve as an underlying biological mechanism by which PTSD and other fear-and anxietybased disorders are highly co-morbid with CVD (Boscarino and Chang, 1999a) and metabolic syndrome (Weiss et al, 2011), as well as other physical illnesses (Boscarino, 2004).”
From Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond (2017) · cites this paper as Boscarino and Chang, 1999a
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- Authors
- Boscarino, J. A., & Chang, J.
- Affiliations
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Catholic Health Initiatives (US)
- Corresponding author
- Boscarino, Joseph A.
- Venue
- Annals of Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1999-09
- Volume
- 21
- Issue
- 3
- Pages
- 227-234
- ISSN
- 0742-5554 (ISSN-L)
- 0883-6612
- 1532-4796
- OpenAlex
- W2038932336
- Cited by
- 216
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 2 · 2022: 2 · 2021: 8 · 2020: 4 · 2019: 7 · 2018: 3 · 2017: 6 · 2016: 11 · 2015: 8 · 2014: 7 · 2013: 13 · 2012: 7
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- National Institute of Mental Health (MH 19105, T32MH019105)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- post-traumatic stress disorder, coronary artery disease, electrocardiographic abnormalities, atrioventricular conduction defects, myocardial infarction, cardiac arrhythmias, depression, generalized anxiety disorder, psychological distress, veterans, combat exposure, sympathoadrenal response, military service duration
- MeSH terms
- Aged, Anxiety, Coronary Disease, Depression, Electrocardiography, Heart Rate, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Stress Disorders, Post-Traumatic, United States, Veterans, Age of Onset
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