Women who experience traumatic events or develop post-traumatic stress disorder (PTSD) may have a greater risk of future cardiovascular disease than women with no traumatic history, according to research in the American Heart Association (AHA) journal Circulation.

In the first major study of PTSD and onset of cardiovascular disease (both heart attacks and strokes) exclusively in women, researchers examined about 50,000 participants in the Nurses’ Health Study II over 20 years.

PTSD occurs in some people after traumatic events (such as a natural disaster, unwanted sexual contact or physical assault). Patients may experience flashbacks of the trauma, insomnia, fatigue, trouble remembering or concentrating, and emotional numbing. Other symptoms include nightmares, irritability or being startled easily. PTSD is twice as common in women as in men.

In the study:

• Women with four or more PTSD symptoms had 60 percent higher rates of cardiovascular disease compared to women who weren’t exposed to traumatic events.
• Women with no PTSD symptoms but who reported traumatic events had 45 percent higher rates of cardiovascular disease.
• Almost half of the association between elevated PTSD symptoms and cardiovascular disease was accounted for by unhealthy behaviors like smoking, obesity, lack of exercise and medical factors such as high blood pressure.

Mental health affects physical health

“PTSD is generally considered a psychological problem, but the take-home message from our findings is that it also has a profound impact on physical health, especially cardiovascular risk,” said Jennifer Sumner, Ph.D., lead author and an Epidemiology Merit Fellow at Columbia University’s Mailman School of Public Health in New York City and a Visiting Scientist at the Harvard T.H. Chan School of Public Health in Boston. “This is not exclusively a mental problem — it’s a potentially deadly problem of the body as well.”

Most studies of cardiovascular disease risk in PTSD patients have been conducted in men who have served in the military or among disaster survivors.

The current study, conducted by a team of researchers at Columbia and Harvard-Chan, is unique in that it examined women from the community who were exposed to a variety of traumatic events.

Mind and body

Our results provide further evidence that PTSD increases the risk of chronic disease,” said. Karestan C. Koenen, the study’s senior author and Professor of Epidemiology at Columbia University Mailman School of Public Health and Harvard T. H. Chan School of Public Health. “The medical system needs to stop treating the mind and the body as if they are separate. Patients need access to integrated mental and physical healthcare.”

Researchers used a questionnaire to evaluate different types of traumatic experiences and PTSD symptoms. They also considered cardiovascular disease risk factors such as obesity, lack of exercise, diabetes, cigarette smoking, high blood pressure, and other contributors to cardiovascular health such as excessive alcohol use, and hormone replacement use.

PTSD emerged as a risk factor for cardiovascular disease in a sample of women under the age of 65. Physicians should be aware of this link and screen for cardiovascular disease risk, as well as monitor related health conditions and behaviors, including encouraging changes in lifestyle factors that may increase this risk, Sumner said.

Most don't get treatment

More than half of the people in the United States who suffer from PTSD don’t get treatment, especially minorities. Women need to get mental healthcare to treat symptoms as well as be monitored for signs of cardiovascular problems, she said.

Other co-authors are Laura D. Kubzansky, Ph.D.; Andrea L. Roberts, Ph.D.; Mitchell S.V. Elkind, M.D., Ph.D.; Jessica Agnew-Blais, Sc.D.; Qixuan Chen, Ph.D.; Magdalena Cerda, Ph.D.; Kathryn M. Rexrode, M.D.; Janet W. Rich-Edwards, Sc.D.; Donna Spiegelman, Sc.D.; Shakira F. Suglia, Sc.D.; and Eric B. Rimm, Sc.D. Authors listed no disclosures.

The National Institutes of Health funded the study.