Impact of posttraumatic stress disorder on incident cardiovascular outcomes in women veterans: a retrospective longitudinal study
TL;DR
PTSD is associated with a broad spectrum of CVD outcomes in women veterans and associations of PTSD with PHTN and AS, novel outcomes in the PTSD-CVD literature—including in women veterans are indicated.
Abstract
Summary Background Women veterans are a growing—yet understudied—population with a high psychiatric and cardiovascular disease (CVD) risk burden. This study evaluated the association of posttraumatic stress disorder (PTSD) with a wide range of incident CVD outcomes in a large, nationally representative cohort of women veterans. Methods In this retrospective longitudinal study, Veterans Health Administration (VHA) electronic health records were used to identify women veterans aged ≥18 years receiving care from 1/1/2000 to 12/31/2019 in the USA. Women with prior CVD at baseline were excluded. Participants with PTSD (n = 101,448) were matched 1:1 to women without PTSD on demographic, clinical, and healthcare utilization factors. Diagnoses were based on International Classification of Diseases codes. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of PTSD with an incident CVD composite (IHD, stroke/transient ischemic attack [TIA], heart failure [HF], atrial fibrillation, peripheral arterial disease, pulmonary hypertension [PHTN], venous thromboembolism [VTE], and aortic valve stenosis [AS]), and each component outcome. Findings The analytic sample comprised 202,896 women veterans (mean age = 39.1 years). Over approximately 6 years of follow-up, PTSD was associated with a greater rate of developing the CVD composite (HR = 1.24, 95% CI: 1.20–1.28). PTSD was also associated with greater incidence of IHD (HR = 1.30, 95% CI: 1.23–1.37), stroke/TIA (HR = 1.29, 95% CI: 1.21–1.38), HF (HR = 1.10, 95% CI: 1.02–1.18), PHTN (HR = 1.17, 95% CI: 1.02–1.35), VTE (HR = 1.34, 95% CI: 1.23–1.45), and AS (HR = 1.23, 95% CI: 1.03–1.46). Particularly strong associations were observed in women <40 years and in American Indian/Alaska Native and Hispanic/Latina women. Interpretation PTSD is associated with a broad spectrum of CVD outcomes in women veterans. Results also indicate associations of PTSD with PHTN and AS, novel outcomes in the PTSD-CVD literature—including in women veterans. Targeted studies are needed to better understand underlying mechanisms. Funding This research was funded by a grant from the Department of Defense Office of Congressionally Directed Medical Research Programs.The funder had no role in the study design, data collection, analysis, interpretation, or writing of the manuscript.