An
increasing body of evidence indicates that posttraumatic stress
disorder, a common anxiety disorder in both veteran and nonveteran
populations, is associated with major forms of cardiovascular disease
including those attributed to atherosclerosis such as coronary heart
disease and thromboembolic stroke.
Persons with PTSD have also been reported to be more likely to have
hypertension, hyperlipidemia, obesity, and cardiovascular disease [1].
These findings are important to the field of cardiology since coronary
heart disease may develop over time as a result of hemodynamic factors
(for example, elevated blood pressure with turbulence and sheer stress
within coronary arteries), hyperlipidemia, and events such as the
rupture of atherosclerotic plaques and thrombus formation [2].
This
review summarizes cardiovascular alterations linked to PTSD including
results from epidemiologic and clinical studies and possible biological
mechanisms. BACKGROUND Individuals may develop PTSD after being exposed
to a traumatic event such as combat experiences, a motor vehicle crash,
or sexual assault [3]. Symptoms of PTSD may include nightmares,
intrusive thoughts, or other re-experiencing phenomena, the avoidance of
situations that remind the person of the traumatic event, a feeling of
numbness or being socially detached from family and friends, and
hyper-arousal (for example, feeling angry, irritable and “on edge,” or
having difficulty concentrating).
Hyper-arousal
or hypervigilance includes a rapid and pronounced reaction to stressors which may lead to a preoccupation with signs of threat and emotional distress.
Persons with PTSD may have other challenges such as difficulties with
employment, relationships, or other health conditions (for example,
depression, alcohol abuse or drug dependency). Effective psychological
and medical treatments for PTSD include group or individual
psychotherapy (for example, cognitive-behavioral therapy) and
pharmacotherapy such as the use of selective serotonin reuptake
inhibitors [4]. Cognitive-behavioral therapy helps patients to address
their traumatic memories and distorted cognitions (for example, by
providing education about the nature of PTSD and stress responses and
helping the individual with the integration of the traumatic events).
*Address
correspondence to this author at the Environmental Epidemiology Service
(135), Environmental Health Strategic Healthcare Group, Office of Public
Health and Environmental Hazards, 810 Vermont Avenue, NW, Washington,
DC 20420, USA; Tel: (202) 266-4656; E-mail steven.coughlin@va.gov
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