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Heart Health, Explained

PTSD: Post-Traumatic Stress Disorder and Increased Risk of Cardiovascular Disease

Previous studies, based mostly on self-report measures, show that individuals with Post-Traumatic Stress Disorder (PTSD) are at increased risk of cardiovascular disease. Now in a new study in Biological Psychiatry, reported December 2, 2013 by the online research news site Science Daily, investigators detected chest pain related to arterial blockage in 17 percent of the study participants with PTSD and only 10 percent of participants without PTSD. (All of the participants were recruited from U.S. Veterans Affairs Medical Centers.) “Increased risk for cardiac ischemia may turn out to be an important new concern for individuals suffering from long-standing untreated PTSD,” commented Dr. John Krystal, Editor of Biological Psychiatry and Chair of Yale’s Department of Psychiatry.

Post-Traumatic Stress Disorder Q&A

Q: Do we know how Post Traumatic Stress Disorder (PTSD) may affect the heart?

A: Persons with PTSD, a common anxiety disorder in both veteran and non-veteran populations, have been reported to have an increased risk of high blood pressure, high cholesterol levels, obesity, and cardiovascular disease. PTSD has been linked to high levels of stress hormones, inflammation and blood clotting. These factors have been associated with disruption of cholesterol plaque in the blood vessel wall leading to blood clot formation in the blood vessel supplying the heart muscle, which ultimately can cause a heart attack. However, researchers are not sure why PTSD is associated with these risk factors. The evidence so far suggests that PTSD may affect different parts of the nervous system, resulting in increased blood pressure and changes in heart rate (either higher or lower), and may be associated with an increased susceptibility to serious abnormal heart rhythms. These processes may cause or worsen coronary artery damage or blockage. The types of stressful life events that can commonly lead to PTSD include assault, violence, experiencing combat in war, natural disasters, divorce, loss of job or retirement savings, business failure, major family conflict, major personal injury, death of a spouse, or illness, death or major illness of a close family member.

Q: Most but not all the study participants were men (women accounted for 6 percent). However, given the rate of PTSD is higher among women than men, how important a role might PTSD play in heart disease risk among women?

A: Most of the studies on PTSD and heart disease risk have been conducted with war veterans, the majority of whom are men. Unprecedented numbers of U.S. military women have returned from Iraq and Afghanistan after experiencing combat, and Women’s Health Research at Yale and the U.S. Department of Veterans Affairs are collaborating on a nationwide study to see if there are gender differences in how female and male combat veterans readjust to civilian life – with PTSD as a major focus of this investigation. We’ll have to wait for the study to be completed. We already know, in general, that PTSD is twice as common among women as it is in men, and heart disease is the leading cause of death among women. So PTSD could very well play a more important role for women than it does for men in the development of coronary heart disease. Unfortunately, there is limited research examining PTSD and heart disease in civilian populations, especially women. However, in one study of civilian women, those found to have high levels of PTSD symptoms linked to traumatic life events such as assault, accidents, or natural disasters had three times the risk of future coronary heart disease compared to women reporting no PTSD symptoms. What is clear is that this area of women’s health needs more investigation.

Q: This study published in Biological Psychiatry appears to support the need to coordinate primary and mental health care to improve treatment for these co-occurring conditions. Is there a trend toward coordinated care in cardiovascular health?

A: There is indeed a growing trend towards what we call “integrative care” in cardiovascular health. Currently, many physicians still work in isolation, with psychiatrists or other mental health providers treating depression, stress and other psychological issues, and cardiologists treating cardiovascular disease. But experts are increasingly proposing that health care providers work together in a multidisciplinary “Psychocardiology” subspecialty. Psychocardiology has arisen as research on the effect of psychological and behavioral factors on heart disease risk and recovery has shown to affect treatment and recovery outcomes.


Answers to your questions on timely topics in cardiac care to help make sense of research reports in the media. The series includes questions on your heart and the effect of medications, exercise, diet, and hormones.

Team Specialist

Ruth Goldberg, PhD, Clinical Psychologist, McConnell Heart Health Center, OhioHealth Healthcare System, Columbus, Ohio

Q&A Editor

Teresa Caulin-Glaser, MD, FACC, FAACVPR System Vice President, Heart & Vascular Services OhioHealth Healthcare System, Columbus, Ohio

Heart Health Explained is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.