Objective Evidence of Myocardial Ischemia in Patients with Posttraumatic Stress Disorder
Open accessAbstract
Background Patients with posttraumatic stress disorder (PTSD) are at increased risk for cardiovascular disease (CVD), but few studies have included objective measures of CVD and how PTSD causes CVD remains unknown. We sought to determine the association between PTSD and objectively assessed CVD and examine potential underlying mechanisms. Methods Outpatients from two Veterans Affairs Medical Centers were enrolled from 2008 to 2010. Posttraumatic stress disorder was identified using the Clinician Administered PTSD Scale, and standardized exercise treadmill tests were performed to detect myocardial ischemia. Results Of the 663 participants with complete data, ischemia was present in 17% of patients with PTSD versus 10% of patients without PTSD (p = .006). The association between PTSD and ischemia remained significant after adjusting for potential confounders (age, sex, prior CVD) and mediators (traditional cardiac risk factors, C-reactive protein, obesity, alcohol use, sleep quality, social support, and depression), adjusted odds ratio (OR) 2.42, 95% confidence interval (CI) 1.39 to 4.22, p = .002. Findings remained significant when those with prior CVD were excluded (fully adjusted OR 2.24, 95% CI 1.20-4.18, p = .01) and when continuous PTSD symptom score was used as the predictor (fully adjusted OR per 10-point change in Clinician Administered PTSD Scale score 1.12, 95% CI 1.03-1.22, p = .01). Conclusions Posttraumatic stress disorder was associated with ischemic changes on exercise treadmill tests independent of traditional cardiac risk factors, C-reactive protein, and several health behaviors and psychosocial risk factors, suggesting additional mechanisms linking PTSD and ischemia should be explored. The association of PTSD and ischemia among patients without known CVD highlights an opportunity for early interventions to prevent progression of cardiovascular disease.
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The association of PTSD and CVD is confirmed by objective tests of cardiovascular health and function such as nuclear imaging.
“and confirmed the association of PTSD and CVD by using objective tests of cardiovascular health and function such as nuclear imaging. 28-30”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [28]
The Discussion reports that this study found an association between PTSD and CVD using objective exercise treadmill testing for myocardial ischemia. It did not use nuclear imaging; the Introduction describes positron emission tomography findings from a prior study. Thus the objective-testing claim is supported, but nuclear imaging is not a test this source used. (LLM, conf=0.85)
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- Authors
- Turner, J. H., Neylan, T. C., Schiller, N. B., Li, Y., & Cohen, B. E.
- Affiliations
- University of California, San Francisco (US)
- San Francisco VA Medical Center (US)
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 74
- Issue
- 11
- Pages
- 861-866
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC4005370
- OpenAlex
- W2067285181
- Cited by
- 73
- References
- 49
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 1 · 2021: 9 · 2020: 5 · 2019: 8 · 2018: 3 · 2017: 6 · 2016: 8 · 2015: 9 · 2014: 6 · 2013: 1
- FWCI
- 8.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23 HL 094765-0, K23HL094765)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Keywords
- post-traumatic stress disorder, myocardial ischemia, cardiovascular disease, treadmill exercise testing, veterans, C-reactive protein, cardiovascular risk factors, PTSD symptom severity
- MeSH terms
- Exercise Test, Female, Humans, Male, Middle Aged, Risk Factors, Stress Disorders, Post-Traumatic, Veterans, Myocardial Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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