Post-Traumatic Stress Disorder and Incidence of Coronary Heart Disease: A Twin Study

• Published in: Journal of the American College of Cardiology 2013-09, Vol.62 (11), p.970-978
• Main Authors: VACCARINO, Viola, GOLDBERG, Jack, ROOKS, Cherie, SHAH, Amit J, VELEDAR, Emir, FABER, Tracy L, VOTAW, John R, FORSBERG, Christopher W, BREMNER, J. Douglas
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; Cardiology. Vascular system; Coronary Artery Disease - epidemiology; Coronary Artery Disease - etiology; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Coronary heart disease; Diseases in Twins; Follow-Up Studies; Health Surveys; Heart; Humans; Incidence; Male; Medical sciences; Middle Aged; Myocardial Perfusion Imaging; Positron-Emission Tomography; Post-traumatic stress disorder; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Registries; Risk Factors; Stress Disorders, Post-Traumatic - complications; Twins - statistics & numerical data; Twins, Dizygotic; Twins, Monozygotic; United States - epidemiology; Veterans - statistics & numerical data; Vietnam Conflict
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.04.085

The aim of this study was to determine whether post-traumatic stress disorder (PTSD) is associated with coronary heart disease (CHD) using a prospective twin study design and objective measures of CHD. It has long been hypothesized that PTSD increases the risk of CHD, but empirical evidence using objective measures is limited. We conducted a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Among twin pairs without self-reported CHD at baseline, we selected pairs discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition. All underwent a clinic visit after a median follow-up of 13 years. Outcomes included clinical events (myocardial infarction, other hospitalizations for CHD and coronary revascularization) and quantitative measures of myocardial perfusion by [(13)N] ammonia positron emission tomography, including a stress total severity score and coronary flow reserve. A total of 562 twins (281 pairs) with a mean age of 42.6 years at baseline were included in this study. The incidence of CHD was more than double in twins with PTSD (22.6%) than in those without PTSD (8.9%; p < 0.001). The association remained robust after adjusting for lifestyle factors, other risk factors for CHD, and major depression (odds ratio: 2.2; 95% confidence interval: 1.2 to 4.1). Stress total severity score was significantly higher (+95%, p = 0.001) and coronary flow reserve was lower (-0.21, p = 0.02) in twins with PTSD than in those without PTSD, denoting worse myocardial perfusion. Associations were only mildly attenuated in 117 twin pairs discordant for PTSD. Among Vietnam-era veterans, PTSD is a risk factor for CHD.