Females with higher symptoms of post-traumatic stress disorder had 60 percent elevated rates of having a heart attack or stroke compared with women who never experienced trauma, according to a new study.

Trauma exposure alone, in other words, reporting trauma without any symptoms of PTSD, also increased the risk for heart attack and stroke by almost 50 percent. Cardiovascular risk in women who experienced trauma with one to three symptoms of PTSD showed no change.

The study analyzed nearly 50,000 younger and middle-aged women in the Nurses’ Health Study II. 80 percent of them reported experiencing a traumatic event in their lives.

More than half of this group (58 percent), reported no symptoms of PTSD. Those reporting symptoms of PTSD were split evenly between those with one to three symptoms and those with four or more symptoms, a commonly used clinical cut-off for PTSD.

Psychological Trauma

Such factors as smoking, lack of physical activity and medical factors like hypertension and the use of antidepressants accounted for nearly half the association between PTSD and cardiovascular disease in women with four or more symptoms of PTSD, but less than 15 percent in women who reported trauma without PTSD.

First author Jennifer Sumner, Ph.D., Epidemiology Merit Fellow at Columbia’s Mailman School and Visiting Scientist at the Harvard T.H. Chan School, said:

“Posttraumatic stress is truly heartbreaking. Our findings suggest that psychological impact of trauma is not limited to a woman’s emotional health but also affects her heart health."

Although further research is needed, the authors say PTSD may disrupt physiological stress systems such as the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, as well as lead to various unhealthy behaviors that may increase risk of heart attack and stroke.

Senior author Karestan Koenen, Ph.D., a professor of epidemiology at Columbia’s Mailman School and the Harvard T.H. Chan School, said:

“PTSD is twice as common in women than in men, and women with PTSD are more likely to have severe and persistent symptoms. Likewise, women with cardiovascular disease are more likely to be hospitalized and die from a heart attack compared with men. For all these reasons, it’s critical that we understand how PTSD contributes to cardiovascular disease in women."

In contrast to previous research, which mostly focused on men with PTSD related to combat, the current study looked at women, and a wide range of traumas, from sexual and physical assault to surviving a natural disaster.

Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women Jennifer A. Sumner, Laura D. Kubzansky, Mitchell S.V. Elkind, Andrea L. Roberts, Jessica Agnew-Blais, Qixuan Chen, Magdalena Cerdá, Kathryn M. Rexrode, Janet W. Rich-Edwards, Donna Spiegelman, Shakira F. Suglia, Eric B. Rimm, and Karestan C. Koenen Circulation. 2015; published online before print June 29 2015, doi:10.1161/CIRCULATIONAHA.114.014492

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