EClinicalMedicine · 2026
Impact of posttraumatic stress disorder on incident cardiovascular outcomes in women veterans: a retrospective longitudinal study.
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Ebrahimi Ramin, Dennis Paul A, Alvarez Carlos A, Shroyer A Laurie, Beckham Jean C, Sumner Jennifer A
Аннотация
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.
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.