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PTSD can lead to heart disease

Post-traumatic stress disorder can increase the risk of cardiovascular disease and it is not just combat veterans at risk, doctors said Monday.

Dr. Steven S. Coughlin, an adjunct professor of epidemiology at the Rollins School of Public Health and a former epidemiologist for the Department of Veterans Affairs, provided an overview of PTSD and the risk of heart disease. The effects of PTSD can have adverse effects on a number of systems that can affect the cardiovascular system, he said.

PTSD can release stress hormones, similar to the "fight or flight response" and much like acute stress, Coughlin said. Patients with PTSD tend to have higher blood pressure levels and heart rates, particularly in response to loud noises or disturbing images, he said.

It can also lead to an increase in cell signals that promote inflammation and an overreaction of the immune system and can increase the risk of atherosclerosis and heart disease, Coughlin said. Those with PTSD tend to have higher levels of bad cholesterol and lower levels of the good cholesterol that help protect against heart disease, he said.

Studies of veterans from World War II, Korea and Vietnam find higher levels of heart disease and risk of heart disease. A study of Finnish World War II veterans, for instance, found they were 1.7 times more likely to die from heart disease if they had been wounded or injured in action.

Some of the stress hormones also increase insensitivity to insulin and put people at greater risk of diabetes and metabolic syndrome, where diabetes, obesity and heart disease seem to interact to worsen health. That already affects about a quarter of the people older than 20 and about 45 percent of people older than 50, Coughlin said. A 2009 study of veterans in South Carolina found that among those with PTSD the severity of their PTSD was an "important indicator" of their risk for metabolic syndrome, he said.

About 10 percent of the U.S. population suffers from PTSD and many were not as a result of combat, but accidents or disasters or violence, Coughlin said. That could help explain why firefighters and police officers are also at higher risk of cardiovascular disease, said Dr. Neal Weintraub, the Kupperman Endowed Chair in Cardiovascular Science at GRU.

"You've got to look beyond the veterans," he said.

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