Cited by 247Cardiac Health and Mental HealthPosttraumatic Stress Disorder ResearchCardiac Imaging and Diagnostics

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Post-Traumatic Stress Disorder and Incidence of Coronary Heart Disease

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Vaccarino, Viola, Goldberg, Jack, Rooks, Cherie, Shah, Amit J., Veledar, Emir, Faber, Tracy L., Votaw, John R., Forsberg, Christopher W., Bremner, J. Douglas·2013·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2013.04.085PMC PMC3823367

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Abstract

Objectives The aim of this study was to determine whether post-traumatic stress disorder (PTSD) is associated with coronary heart disease (CHD) using a prospective twin study design and objective measures of CHD. Background It has long been hypothesized that PTSD increases the risk of CHD, but empirical evidence using objective measures is limited. Methods We conducted a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Among twin pairs without self-reported CHD at baseline, we selected pairs discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition. All underwent a clinic visit after a median follow-up of 13 years. Outcomes included clinical events (myocardial infarction, other hospitalizations for CHD and coronary revascularization) and quantitative measures of myocardial perfusion by [(13)N] ammonia positron emission tomography, including a stress total severity score and coronary flow reserve. Results A total of 562 twins (281 pairs) with a mean age of 42.6 years at baseline were included in this study. The incidence of CHD was more than double in twins with PTSD (22.6%) than in those without PTSD (8.9%; p < 0.001). The association remained robust after adjusting for lifestyle factors, other risk factors for CHD, and major depression (odds ratio: 2.2; 95% confidence interval: 1.2 to 4.1). Stress total severity score was significantly higher (+95%, p = 0.001) and coronary flow reserve was lower (-0.21, p = 0.02) in twins with PTSD than in those without PTSD, denoting worse myocardial perfusion. Associations were only mildly attenuated in 117 twin pairs discordant for PTSD. Conclusions Among Vietnam-era veterans, PTSD is a risk factor for CHD.

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Authors: Vaccarino, V., Goldberg, J., Rooks, C., Shah, A. J., Veledar, E., Faber, T. L., Votaw, J. R., Forsberg, C. W., & Bremner, J. D.
Affiliations: Emory University (US)
University of Washington (US)
Corresponding author: Vaccarino, Viola
ORCID: Vaccarino, Viola
Goldberg, Jack
Shah, Amit J.
Veledar, Emir
Forsberg, Christopher W.
Bremner, J. Douglas
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2013-09
Volume: 62
Issue: 11
Pages: 970-978
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2013.04.085
PMC: PMC3823367
OpenAlex: W1562554724
Cited by: 247
References: 47
Citations by year: 2026: 7 · 2025: 11 · 2024: 11 · 2023: 21 · 2022: 19 · 2021: 22 · 2020: 17 · 2019: 23 · 2018: 21 · 2017: 22 · 2016: 27 · 2015: 27 · 2014: 12 · 2013: 5
FWCI: 16.10
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 374 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Florida International University Digital Commons (Florida International University) (submittedVersion)
Funders: National Institutes of Health (K24HL077506, R01 HL68630, R01 AG026255, K24 MH076955, R21HL093665-01A1S1)
American Heart Association (0245115N)
National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000454)
Emory University General Clinical Research Center (MO1-RR00039)
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 › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords: post-traumatic stress disorder, coronary artery disease, myocardial perfusion, coronary flow reserve, myocardial infarction, coronary revascularization, major depressive disorder, Vietnam War veterans, stress severity, cardiovascular risk factors
MeSH terms: Adult, Coronary Artery Disease, Diseases in Twins, Follow-Up Studies, Health Surveys, Humans, Male, Middle Aged, Prospective Studies, Registries, Risk Factors, Stress Disorders, Post-Traumatic, Twins, Twins, Dizygotic, Twins, Monozygotic, United States, Veterans, Incidence, Vietnam Conflict, Positron-Emission Tomography, Myocardial Perfusion Imaging

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