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Risk factors associated with posttraumatic stress disorder in US veterans: A cohort study.

ABSTRACT: To assess the association between clinical and exercise test factors and the development of posttraumatic stress disorder (PTSD) in US Veterans.Exercise capacity, demographics and clinical variables were assessed in 5826 veterans (mean age 59.4 ± 11.5 years) from the Veterans Affairs Healthcare System in Palo Alto, CA. The study participants underwent routine clinical exercise testing between the years 1987 and 2011. The study end point was the development of PTSD.A total of 723 (12.9%) veterans were diagnosed with PTSD after a mean follow-up of 9.6 ± 5.6 years. Drug abuse (HR: 1.98, CI: 1.33-2.92, p = .001), current smoking (HR: 1.57, CI: 1.35-2.24, p <.001), alcohol abuse (HR: 1.58, CI: 1.12-2.24, p = .009), history of chest pain (HR: 1.48, CI: 1.25-1.75, p <.001) and higher exercise capacity (HR: 1.03, CI: 1.01-1.05, p = .003) were strong independent risk factors for PTSD in a univariate model. Physical activity pattern was not associated with PTSD in either the univariate or multivariate models. In the final multivariate model, current smoking (HR: 1.30, CI: 1.10-1.53, p = .002) history of chest pain (HR: 1.37, CI: 1.15-1.63, p <.001) and younger age (HR: 0.97, CI: 0.97-0.98, p <.001) were significantly associated to PTSD.Onset of PTSD is significantly associated with current smoking, history of chest pain and younger age. Screening veterans with multiple risk factors for symptoms of PTSD should therefore be taken into account.

SUBMITTER: Muller J

PROVIDER: S-EPMC5526531 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Risk factors associated with posttraumatic stress disorder in US veterans: A cohort study.

Müller Jan J Ganeshamoorthy Sarmila S Myers Jonathan J

PloS one 20170725 7

<h4>Objective</h4>To assess the association between clinical and exercise test factors and the development of posttraumatic stress disorder (PTSD) in US Veterans.<h4>Patients and methods</h4>Exercise capacity, demographics and clinical variables were assessed in 5826 veterans (mean age 59.4 ± 11.5 years) from the Veterans Affairs Healthcare System in Palo Alto, CA. The study participants underwent routine clinical exercise testing between the years 1987 and 2011. The study end point was the deve ...[more]

PMID: 28742837

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Project description:BackgroundCurrent research in behavioral cardiology reveals a significant association between posttraumatic stress disorder (PTSD) and increased risk for cardiovascular disease and mortality; however, the underlying mechanisms remain poorly understood. We hypothesized that patients with PTSD would exhibit endothelial dysfunction, a potential mechanism involved in the development and progression of cardiovascular disease.Methods and resultsA total of 214 outpatients treated at the San Francisco Veterans Affairs Medical Center underwent tests of endothelial function and evaluation for PTSD. Flow-mediated vasodilation of the brachial artery was performed to assess endothelial function, and current PTSD status was defined by the PTSD Checklist, based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), with a score ?40. Multivariable linear regression models were used to estimate the association between PTSD status and endothelial function. Patients with PTSD (n=67) were more likely to be male (99% versus 91%, P=0.04) and to have depression (58% versus 8%, P<0.0001) and were less likely to be on an angiotensin-converting enzyme inhibitor (17% versus 36%, P=0.007) or ?-blocker treatment (25% versus 41%, P=0.03). Univariate analysis demonstrated that patients with PTSD had significantly lower flow-mediated vasodilation (5.8±3.4% versus 7.5±3.7%; P=0.003); furthermore, lower flow-mediated vasodilation was associated with increasing age (P=0.008), decreasing estimated glomerular filtration rate (P=0.003), hypertension (P=0.002), aspirin (P=0.03), and ?-blocker treatments (P=0.01). In multivariable analysis, PTSD remained independently associated with lower flow-mediated vasodilation (P=0.0005).ConclusionsAfter adjusting for demographic, comorbidity, and treatment characteristics, PTSD remained associated with worse endothelial function in an outpatient population. Whether poor endothelial function contributes to the higher risk of cardiovascular disease in patients with PTSD deserves further study.

Dataset Information

Risk factors associated with posttraumatic stress disorder in US veterans: A cohort study.

Publications

Risk factors associated with posttraumatic stress disorder in US veterans: A cohort study.

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