War trauma may lead to future heart attacks
Study of nearly 2,000 veterans links symptoms of PTSD to
heart disease
Jan 2, 2007
http://www.msnbc.msn.com/id/16429693
A groundbreaking study of 1,946 male veterans of World War II and Korea suggests
that vets with symptoms of post-traumatic stress disorder are at greater risk of
heart attacks as they age.
The new study is the first to document a link between PTSD symptoms and future
heart disease, and joins existing evidence that vets with PTSD also have more
autoimmune diseases such as arthritis and psoriasis.
A second study, funded by the Army, found that soldiers returning from combat in
Iraq with post-traumatic stress disorder reported worse physical health, more
doctor visits and more missed workdays. The Army study is based on a survey of
2,863 soldiers one year after combat.
“The burden of war may be even greater than people think,” said the first
study’s lead author, Laura Kubzansky of the Harvard School of Public Health, who
studies anxiety, depression and anger as risk factors for heart disease. Her
work, with colleagues from Harvard and Boston University, appears in Monday’s
Archives of General Psychiatry.
Their study was funded by the National Institutes of Health and the Department
of Veterans Affairs. The Army study appears in Monday’s American Journal of
Psychiatry.
The possible link with heart disease didn’t surprise one Iraq veteran diagnosed
with PTSD.
'Wake-up call'
“It didn’t take a rocket scientist to figure out,” said John Oliveira of New
Bedford, Mass., a former Navy public affairs officer and veteran of Iraq and
Afghanistan. “It should also be a wake-up call that the cost to treat those of
us suffering from PTSD could dramatically increase as we age.”
Medical authorities first accepted post-traumatic stress disorder as a
psychiatric condition in 1980 at the urging of Vietnam veterans.
In PTSD, the body’s normal hormonal response to stress becomes trigger-happy,
scientists believe. Long after traumatic events, people remain edgy, fearful and
prone to nightmares and flashbacks. The continual release of adrenaline prompted
by these symptoms may wear down the cardiovascular system, Kubzansky said.
“It’s not enough to simply welcome them home and do some immediate evaluation or
help with reintegration,” she said. “They need to be tracked and watched
carefully.”
The Harvard and Boston University researchers analyzed data from the Veterans
Administration Normative Aging Study, a long-term research project tracking
Boston-area vets.
They looked at health records of men who completed either a 46-item
questionnaire measuring PTSD symptoms in 1986, or a different 35-item PTSD
assessment in 1990. Both questionnaires are recognized tools for diagnosing PTSD
and ask about symptoms such as sleep problems, nightmares, numbness, a
heightened sense of being on guard and intrusive memories of traumatic events.
Over the 10 to 15 years after completing the questionnaires, the vets with more
PTSD symptoms were more likely to have heart attacks. For each level increase in
symptoms on the 1990 assessment, the risk of heart attack or chest pain rose 18
percent — even after the researchers took into account known heart disease risk
factors such as smoking, alcohol use and high blood pressure.
Although the men had different levels of PTSD symptoms, very few had enough
symptoms for a true diagnosis, Kubzansky said. The study needs to be repeated to
see if the findings hold true for PTSD-diagnosed veterans, and for women, she
said.
The data also didn’t track how frequently the men exercised, so researchers
couldn’t tell if the men with PTSD symptoms were getting more or less exercise
than other veterans.
Exercise a possible factor
Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical
Center, called the study “impressive.” He said one symptom of PTSD is avoiding
activity, which could account for some of the effect on the heart.
Kennedy, who was not involved in the study, said treatment options for PTSD
include drugs, talk therapy and behavioral changes such as getting more exercise
and taking action to solve small problems in life rather than shutting down
emotionally.
“We’ve got a whole generation of veterans coming back (from Iraq and
Afghanistan) and their health needs are just going to be tremendous,” Kennedy
said.