A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention
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Objective: To examine prospectively early-age heart disease (HD) among a national random sample of 4328 male Vietnam veterans, who did not have HD at baseline in 1985. Studies have suggested that posttraumatic stress disorder (PTSD) may result in cardiovascular disease. However, many past studies had important methodological limitations to their designs. Method: Using Cox regressions, we assessed PTSD, age, race, intelligence, family history, obesity, smoking, alcohol abuse, antisocial personality, and depression in predicting HD mortality at follow-up in December 31, 2000. The men were <65 years old at follow-up. Results: Using two PTSD measures, a Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III) measure (D-PTSD) and one developed by Keane (K-PTSD), we found that among Vietnam theater and era veterans combined (era veterans had no Vietnam service), having PTSD was associated with HD mortality for D-PTSD (hazard ratio (HR) = 2.25, p = .045) and approached significance for K-PTSD (HR = 2.16, p = .066). However, having higher PTSD symptoms on either scale was associated with mortality, with a 5-point increase associated with ∼20% increase in mortality risk (all p < .05). Controlling for lifetime depression only slightly altered the results. The effects for theater veterans alone were stronger (D-PTSD: HR = 2.58, p = .025; K-PTSD: HR = 2.73, p = .022). Among theater veterans, controlling for lifetime depression or combat exposure made little difference. Conclusion: PTSD was prospectively associated with HD mortality among veterans free of HD at baseline. This study suggests that early-age HD may be an outcome after military service among PTSD-positive veterans. TV = theater veteran; EV = era veteran; POW = prisoner of war; PTSD = posttraumatic stress disorder; DIS = Diagnostic Interview Schedule; DSM-III = Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition; HD = heart disease; ECG = electrocardiogram; BP = blood pressure; HPA = hypothalamic-pituitary-adrenocortical; SAM = sympathetic-adrenal-medullary; NDI = National Death Index; HR = hazard ratio; CI = Confidence Interval.
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The very high comorbidity of stress- and trauma-related disorders and cardiovascular disease confirms a central pathophysiological link between the stress axis and the ANS.
“The very high comorbidity of stress- and trauma-related disorders and cardiovascular disease (135–140) confirms a central pathophysiological link between the stress axis and ANS (141–143).”
From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [138]
The Introduction reports higher rates of chronic circulatory disease among veterans with PTSD, supporting an association between trauma-related disorder and cardiovascular disease. The Discussion describes HPA and sympathetic-adrenal-medullary pathways as plausible mechanisms, but also considers behavioral and genetic explanations; it does not establish that the association confirms a central pathophysiological link between the stress axis and ANS. Page numbers are not available in our copy. (LLM, conf=0.87)
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Ferrell, E. L., Russin, S. E., & Flint, D. D. (2022) · Journal of Aggression, Maltreatment & Trauma · doi:10.1080/10926771.2020.1832168 · Cited by 68 · see citing works
Effects of parabolic flight and spaceflight on the endocannabinoid system in humans
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The association between post-traumatic stress disorder and coronary artery disease: a meta-analysis
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Patients with posttraumatic stress disorder exhibit an altered phenotype of regulatory T cells
Jergović, M., Bendelja, K., Vidović, A., Savić, A., Vojvoda, V., Aberle, N., Rabatić, S., Jovanovic, T., & Sabioncello, A. (2014) · Allergy, Asthma & Clinical Immunology · doi:10.1186/1710-1492-10-43 · Cited by 49 · see citing works
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Fear and distress disorders as predictors of heart disease: a temporal perspective
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One's sex, sleep, and posttraumatic stress disorder
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- Authors
- Boscarino, J. A.
- Affiliations
- Geisinger Medical Center (US)
- Corresponding author
- Boscarino, Joseph A.
- ORCID
- Boscarino, Joseph A.
- Venue
- Psychosomatic Medicine
- Published
- 2008-07
- Volume
- 70
- Issue
- 6
- Pages
- 668-676
- ISSN
- 0033-3174 (ISSN-L)
- PMC
- PMC3552245
- OpenAlex
- W1989811349
- Semantic Scholar
- 02e4a6bd3dd55d9301cd99c4efdd9b26b8fa057f
- Cited by
- 434
- References
- 63
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 13 · 2023: 25 · 2022: 12 · 2021: 14 · 2020: 27 · 2019: 29 · 2018: 29 · 2017: 26 · 2016: 32 · 2015: 35 · 2014: 33 · 2013: 40 · 2012: 29
- FWCI
- 25.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01-MH-66403, MH 19105, R01MH066403, T32MH019105)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, heart disease mortality, Vietnam War veterans, cardiovascular disease, combat exposure, depression, PTSD symptom severity, military service
- MeSH terms
- Cause of Death, Coronary Artery Disease, Heart Diseases, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Stress Disorders, Post-Traumatic, United States, Veterans, Survival Analysis, Sentinel Surveillance, Vietnam Conflict
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