PTSD raises likelihood of developing ischemic heart disease

Dear Doctor: I’m the sister of a veteran, and I’m very interested in the recent study about people with PTSD having a higher risk of heart problems. Can you please talk about that? My family suspects our sister has PTSD, but she won’t let us talk about it. We’re worried for her and wish we could help.

Dear Reader: You’re referring to a study that appeared last spring in the medical journal JAMA Cardiology. Researchers found that female veterans living with post-traumatic stress disorder were at significantly increased risk of developing ischemic heart disease. That’s a condition in which the coronary arteries become narrowed, which means the volume of oxygen and nutrients that reach the heart are reduced. Ischemic heart disease can lead to a range of health problems, including heart attack, and it is a leading cause of death worldwide.

The researchers in the study you’re asking about examined two years of electronic health records of nearly 400,000 female military veterans. Roughly one-third of the women in the study had been diagnosed with PTSD. The data showed that female veterans living with post-traumatic stress disorder were 44% more likely to develop ischemic heart disease than were those without PTSD. A previous study found an 18% increase in heart disease among male veterans with PTSD. This all lines up with decades of research, which shows that the biochemical changes set off by chronic stress can cause significant damage to the cardiovascular system.

For those who are unfamiliar, post-traumatic stress disorder is a collection of symptoms that can develop after someone survives an extreme, dangerous or frightening incident. It can be a one-time event, such as a car accident or a physical assault, or it may be an ongoing high-stress situation, such as living or serving in a war zone. It is estimated that up to 20% of those who served in the military actions in Iraq and Afghanistan experience PTSD. People who develop the disorder often have unwanted thoughts or memories associated with the event. This can lead to a persistent undercurrent of anxiety or unease.

Elizabeth Ko, MD and Eve Glazier, MD

People living with PTSD often describe feeling numb, detached or separated from their emotions and unable to return to the rhythms of daily life. They may startle easily, have trouble with sleep, have repeated nightmares, feel unsafe in ordinary situations and experience depression. Treatment focuses on a mix of short- and long-term psychotherapy and the use of medications.

When it comes to your sister’s reluctance to engage with you on the subject of PTSD, know that you’re not alone. Some people associate a diagnosis of PTSD with being weak or damaged. Others worry that instead of helping, treatment might aggravate the trauma. Veterans who aren’t ready to seek professional help may be willing to explore peer-to-peer support. A useful resource, which is part of the Department of Defense and offers free and confidential counseling to veterans and their families, is Military Onesource. You can find the group at militaryonesource.mil.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)


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