Journal of the American College of Cardiology · 2013
Post-traumatic stress disorder and incidence of coronary heart disease: a twin study.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАПоддержка правительства СШАTwin StudyНазвание и аннотация: Перевод в очереди
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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
Аннотация
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.
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.
Предметные рубрики MeSH
AdultCoronary Artery DiseaseDiseases in TwinsFollow-Up StudiesHealth SurveysHumansIncidenceMaleMiddle AgedMyocardial Perfusion ImagingPositron-Emission TomographyProspective StudiesRegistriesRisk FactorsStress Disorders, Post-TraumaticTwinsTwins, DizygoticTwins, MonozygoticUnited StatesVeteransVietnam Conflict