Risk of stroke among patients with post-traumatic stress
                        disorder: nationwide longitudinal study

Chen, Mu Hong; Pan, Tai‐Long; Li, Cheng Ta; Lin, Wei Chen; Chen, Ying Sheue; Lee, Ying Chiao; Tsai, Shih Jen; Hsu, Ju Wei; Huang, Kou‐Yuan; Tsai, Chia Fen; Chang, Wen Han; Chen, Tzeng Ji; Su, Tung Ping; Bai, Ya Mei

doi:10.1192/bjp.bp.113.143610

Cited by 107 publications

(62 citation statements)

References 30 publications

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“…Although investigators have examined posttraumatic stress disorder in relation to a range of health outcomes (including rheumatoid arthritis, stroke, heart disease, and cancer), some of the strongest empirical research, in terms of methodology and findings, has been with cardiometabolic diseases. 70,71 Numerous methodologically rigorous prospective population-based observational studies have found that posttraumatic stress disorder is associated with increased risk of incident CVD [72][73][74][75][76][77][78][79][80][81][82][83][84] and T2DM. [85][86][87] However, whether and how much of the relation between childhood adversity and cardiometabolic disease may be explained by posttraumatic stress disorder is unclear, especially because these studies have included traumatic events over the life course, with a substantial proportion of studies focused on veterans and military service-related trauma, not just adversity during childhood.…”

Section: Mental Health Factorsmentioning

confidence: 99%

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

Suglia¹,

Koenen²,

et al. 2018

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Adverse experiences in childhood and adolescence, defined as subjectively perceived threats to the safety or security of the child's bodily integrity, family, or social structures, are known to be associated with cardiometabolic outcomes over the life course into adulthood. This American Heart Association scientific statement reviews the scientific literature on the influence of childhood adversity on cardiometabolic outcomes that constitute the greatest public health burden in the United States, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. This statement also conceptually outlines pathways linking adversity to cardiometabolic health, identifies evidence gaps, and provides suggestions for future research to inform practice and policy. We note that, despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course. Future studies that focus on mechanisms, resiliency, and vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions. Given that childhood adversities affect cardiometabolic health and multiple health domains across the life course, interventions that ameliorate these initial upstream exposures may be more appropriate than interventions remediating downstream cardiovascular disease risk factor effects later in life.

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Section: Mental Health Factorsmentioning

confidence: 99%

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

Suglia¹,

Koenen²,

et al. 2018

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“…While investigators have examined PTSD in relation to a range of health outcomes (including rheumatoid arthritis, stroke, heart disease, and cancer), some of the strongest empirical research—in terms of methodology and findings—has been with cardiometabolic diseases (Lohr et al , 2015). Numerous methodologically rigorous prospective population-based observational studies have found PTSD is associated with increased risk of incident cardiovascular disease (CVD) (Beristianos et al , 2014, Boscarino, 2006, 2008, Boscarino and Chang, 1999, Chen et al , 2015, Gradus et al , 2015, Jordan et al , 2011, Kubzansky et al , 2009, Kubzansky et al , 2007, Roy et al , 2015, Scherrer et al , 2010, Sumner et al , 2015, Vaccarino et al , 2013) and type 2 diabetes (T2D) (Boyko et al , 2010, Roberts et al , 2015, Vaccarino et al , 2014), even after adjusting for depression (see Table 1). …”

Section: Introductionmentioning

confidence: 99%

Post-traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice

et al. 2016

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Posttraumatic stress disorder (PTSD) has been declared “a life sentence” based on evidence that the disorder leads to a host of physical health problems. Some of the strongest empirical research—in terms of methodology and findings—has shown that PTSD predicts higher risk of cardiometabolic diseases, specifically cardiovascular disease (CVD) and type 2 diabetes (T2D). Despite mounting evidence, PTSD is not currently acknowledged as a risk factor by cardiovascular or endocrinological medicine. This view is unlikely to change absent compelling evidence that PTSD causally contributes to cardiometabolic disease. This review suggests that with developments in methods for epidemiologic research and the rapidly expanding knowledge of the behavioral and biological effects of PTSD the field is poised to provide more definitive answers to questions of causality. First, we discuss methods to improve causal inference using the observational data most often used in studies of PTSD and health, with particular reference to issues of temporality and confounding. Second, we consider recent work linking PTSD with specific behaviors and biological processes, and evaluate whether these may plausibly serve as mechanisms by which PTSD leads to cardiometabolic disease. Third, we evaluate how looking more comprehensively into the PTSD phenotype provides insight into whether specific aspects of PTSD phenomenology are particularly relevant to cardiometabolic disease. Finally, we discuss new areas of research that are feasible and could enhance understanding of the PTSD-cardiometabolic relation, such as testing whether treatment of PTSD can halt or even reverse the cardiometabolic risk factors causally related to CVD and T2D.

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“…Among 5,217 participants in the Taiwan National Health Insurance Research Database, Chen et al found that PTSD was associated with a greater than 3-fold risk of developing stroke (22). We did not find that the magnitude of the association between PTSD and stroke differed significantly by race.…”

Section: Discussionmentioning

confidence: 99%

“…These risk factors, in turn, may predispose those with PTSD to a greater risk of developing chronic disease. Past research has demonstrated associations between PTSD and hypertension (12–15), obesity (16–20), metabolic disease (21), stroke (22) and type 2 diabetes (23–25). A prospective association between PTSD and incident heart disease has been well-established (26–30).…”

Section: Introductionmentioning

confidence: 99%

Black-white disparities in the association between posttraumatic stress disorder and chronic illness

Nobles

Valentine

Borba

et al. 2016

Journal of Psychosomatic Research

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Objective Non-Latino blacks experience a higher proportion of chronic illness and associated disabilities than non-Latino whites. Posttraumatic stress disorder (PTSD) is associated with a greater risk of chronic illness, although few studies have investigated whether the interaction of PTSD with racial disparities may lead to a greater risk of chronic illness among blacks with PTSD than among whites with PTSD. Methods We evaluated data from the population-based National Survey of American Life and the National Comorbidity Survey Replication to investigate the association between race, lifetime PTSD and self-reported chronic illness. Weighted linear and Poisson regression models assessed differences in the magnitude of association between PTSD and chronic illness by race on both the additive and multiplicative scales. Results The magnitude of the association between lifetime PTSD and diabetes was greater among blacks (RD 0.07, 95% CI 0.02, 0.11; RR 1.9, 95% CI 1.4, 2.5) than whites (RD 0.004, 95% CI −0.02, 0.03; RR 1.2, 95% CI 0.7, 1.9) on the additive (p=0.017) scale. The magnitude of the association between lifetime PTSD and heart disease was greater among blacks (RD 0.09, 95% CI 0.05, 0.13) than whites (RD 0.04, 95% CI 0.01, 0.07) on the additive scale at a level approaching significance (p=0.051). Conclusion A lifetime history of PTSD was associated with a significantly greater risk of diabetes among blacks as compared to whites. These findings suggest that continuous exposure to racial inequalities may be associated with a greater risk of PTSD-related health sequela.

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Risk of stroke among patients with post-traumatic stress disorder: nationwide longitudinal study

Abstract: Individuals with PTSD have an increased risk of developing any stroke and ischaemic stroke. Further studies are required to investigate the underlying mechanisms.

Cited by 107 publications

References 30 publications

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

Post-traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice

Black-white disparities in the association between posttraumatic stress disorder and chronic illness

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