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Cited by 247Posttraumatic Stress Disorder ResearchDiabetes, Cardiovascular Risks, and LipoproteinsHIV-related health complications and treatments

The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis

Rosenbaum, Simon, Stubbs, Brendon, Ward, Philip B., Steel, Zachary, Lederman, Oscar, Vancampfort, Davy·2015·Metabolism
DOI 10.1016/j.metabol.2015.04.009
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Abstract

Objective People with posttraumatic stress disorder (PTSD) have a higher mortality than the general population, mainly due to cardiovascular diseases (CVD). Metabolic syndrome (MetS) and its components are highly predictive of CVD. The aim of this meta-analysis was to describe pooled frequencies of MetS and its components in people with PTSD and to compare MetS prevalence in PTSD versus the general population. Method Medline, PsycARTICLES, Embase and CINAHL were searched until 02/2015 for cross-sectional and baseline data of longitudinal studies in adults with PTSD. Two independent reviewers conducted the searches and extracted data. Random effects meta-analysis with a relative risk, subgroups and meta-regression analyses were employed. Results Overall, 9 studies met the inclusion criteria including 9,673 individuals in midlife with PTSD and 6852 general population controls. The pooled MetS prevalence was 38.7% (95% CI = 32.1%-45.6%; Q = 52.1, p < 0.001; N = 9; n = 9,673; age range = 44-61 years). Abdominal obesity was observed in 49.3% (95% CI = 29.7%-69.0%), hyperglycemia in 36.1% (95% CI = 18.8%-55.6%), hypertriglyceridemia in 45.9% (95% CI = 12.2%-81.9%), low high density-lipoprotein-cholesterol in 46.4% (95% CI = 26.4%-67.0%) and hypertension in 76.9% (95% CI = 67.9%-84.8%). The MetS prevalence was consistently high across geographical regions, settings or populations (war veterans or not). Compared with matched general population controls, people with PTSD had an almost double increased risk for MetS (RR = 1.82; 95% CI = 1.72-1.92; p < 0.001). Most analyses were not statistically heterogeneous. Conclusions MetS is highly prevalent in people with PTSD. Routine screening and multidisciplinary management of medical and behavioral conditions is needed. Future research should focus on how cardio-metabolic outcomes are moderated by clinical and treatment characteristics and genetic factors.

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Crossref · 10.1016/j.metabol.2015.04.009

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  • Chronic conditions such as coronary artery disease, fibromyalgia, rheumatoid arthritis, Major Depressive Disorder, and Post Traumatic Stress Disorder are associated with abnormally high cortisol levels and metabolic disruptions.

    “chronic conditions such as coronary artery disease, fibromyalgia, rheumatoid arthritis, and mood disorders such as Major Depressive Disorder (MDD) and Post Traumatic Stress Disorder (PTSD) have also been associated with abnormally high CORT levels and metabolic disruptions ( 5-13 ).”

    From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [7]

    The Limitations section (p. 15) reports that metabolic syndrome and its components are highly prevalent in people with PTSD, supporting that part of the claim. The discussion (p. 14) mentions possible HPA-axis dysfunction, but does not establish abnormally high cortisol levels. The paper does not establish the claimed associations for coronary artery disease, fibromyalgia, rheumatoid arthritis, or MDD. (LLM, conf=0.90)

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  • Many conditions associated with hypercortisolism are accompanied by disruption of normal glucose metabolism while preserving some degree of cortisol rhythmicity.

    “many of these conditions are accompanied by a disruption of normal glucose metabolism while preserving some degree of CORT rhythmicity.”

    From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [7]

    Section 3.3 (p. 10) reports hyperglycemia among people with PTSD, and the discussion (p. 14) mentions HPA dysfunction. The paper does not establish that these conditions involve hypercortisolism or preserve any degree of cortisol rhythmicity. (LLM, conf=0.82)

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  • In hypercortisolism, cortisol levels are higher than normal and in some cases display abnormal rhythmicity, varying by underlying condition.

    “in hypercortisolism, it is not only that CORT levels are higher than normal, but in some cases, they also display abnormal rhythmicity. This varies depending on whether the underlying condition is associated with Cushing's syndrome, depression, PTSD, acute inflammation following major surgery, or chronic inflammatory diseases (e.g., rheumatoid arthritis) ( 2, 5-13, 57-60 ).”

    From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [7]

    The discussion (p. 14) mentions possible HPA-axis dysfunction in PTSD, but does not describe cortisol levels or rhythms. Searches for hypercortisolism, cortisol rhythmicity, and diurnal rhythm found no passage addressing the claim. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • Social determinants including poverty, poor education, unemployment, homelessness and childhood abuse increase the risk for both mental and physical disorders.

    “Social determinants including poverty, poor education, unemployment, homelessness and childhood abuse increase the risk for both mental and physical disorders.89,292”

    From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [89]

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Authors
Rosenbaum, S., Stubbs, B., Ward, P. B., Steel, Z., Lederman, O., & Vancampfort, D.
Affiliations
  • UNSW Sydney (AU)
  • University of Greenwich (GB)
  • KU Leuven (BE)
Corresponding author
Vancampfort, Davy
ORCID
Venue
Metabolism
Publisher
Elsevier BV
Published
2015-08
Volume
64
Issue
8
Pages
926-933
ISSN
0026-0495 (ISSN-L)
DOI
10.1016/j.metabol.2015.04.009
OpenAlex
W2154972467
Cited by
246
References
59
Citations by year
2026: 12 · 2025: 33 · 2024: 33 · 2023: 28 · 2022: 18 · 2021: 20 · 2020: 19 · 2019: 26 · 2018: 16 · 2017: 17 · 2016: 18 · 2015: 6
FWCI
2.75
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Greenwich Academic Literature Archive (University of Greenwich) (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • Lirias (KU Leuven) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
Keywords
post-traumatic stress disorder, metabolic syndrome, prevalence, abdominal obesity, hypertriglyceridemia, low HDL cholesterol, hypertension, hyperglycemia, cardiovascular risk, war veterans, middle-aged adults, comorbidities, multidisciplinary management, trauma-informed care
MeSH terms
Humans, Risk, Stress Disorders, Post-Traumatic, Prevalence, Metabolic Syndrome

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