Combat veterans with post-traumatic stress disorder (PTSD) appear to be at higher risk for coronary heart disease (CHD), according to a recent study of 4,462 male U.S. Army veterans who served during the Vietnam War. The study results suggest that PTSD and other types of severe psychological distress may actually cause heart disease. While the relationship between severe stress exposures and heart disease has been confirmed in animal studies, this association has been difficult to establish in human studies.
In this study, electrocardiogram (ECG) examinations detected a higher rate of heart disorders, including evidence of past heart attacks, among Vietnam veterans who were suffering from PTSD at the time of the study than among other veteran subjects. The ECGs also showed that veterans who were experiencing depression or anxiety had a significantly higher rate of heart problems as well. The findings held true even after controlling for other factors, such as smoking history, drug abuse, alcohol consumption, income, education, race, and age.
"We found a link between long-term, severe psychological distress and ECG results that serve as clear markers for coronary heart disease," said study head Joseph Boscarino, Ph.D., M.P.H., who was with the Department of Outcomes Research at Catholic Health Initiatives in Louisville, Kentucky, at the time the research was conducted. "For these men, combat exposure years ago in Vietnam was the principal reason for PTSD, anxiety, and depression, but we believe that the results would be similar when looking at the consequences of severe distress among other groups of people and within other occupations."
"We believe that this research suggests a clear, definitive linkage between exposure to severe stress and the onset of coronary heart disease in humans," said Boscarino.
In the research, the 4,462 veterans studied received comprehensive medical and psychiatric examinations and Board-certified cardiologists confirmed all the Veterans' ECG results.
Abnormal ECG results showed up in 28 percent of the veterans with PTSD, 24 percent of the veterans with depression, and 22 percent of the veterans with anxiety. Fifteen percent of all of the veterans studied had abnormal results.
Approximately 30 percent of male veterans are known to have developed PTSD after Vietnam service. The study's medical implications are important in the health care of veterans who continue to suffer from PTSD as they age and will be afflicted both with the consequences of severe stress and aging. The results of the research appear in the current issue of Annals of Behavioral Medicine.
The research was funded by the National Institute of Mental Health and the Sisters of Charity of Nazareth Health System in Louisville, Kentucky. Boscarino is now a senior director in the Center for Outcomes Measurement and Performance Assessment with Merck-Medco in Franklin Lakes, New Jersey.
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