Women veterans with PTSD have higher rate of heart disease

Women veterans with posttraumatic stress disorder (PTSD), especially those who are younger and non-white, have an increased risk of developing heart disease, according to a study to be presented at the American Heart Association's Scientific Sessions 2020.

According to the National Institute of Mental Health, PTSD is a mental health condition that develops in some people who have experienced or witnessed a shocking, scary or dangerous event. "Previous research has linked PTSD to higher risks of ischemic heart disease, including heart attacks and heart pain or angina. However, most of those studies have been in men," according to study author Ramin Ebrahimi, M.D., professor of medicine at University of California Los Angeles and director of interventional cardiovascular research and co-director of the Cardiac Catheterization Laboratory at the Greater Los Angeles VA (Veterans Affairs) Medical Center.

"PTSD occurs twice as frequently in women as in men, and rates are particularly high among women veterans. Women veterans are the fastest growing group of patients within the VA health care system. And, despite being at high risk for many disorders including cardiovascular disorders, they have been understudied, underdiagnosed, undertreated and underrepresented in cardiovascular research," Ebrahimi said.

Ebrahimi and colleagues evaluated the medical records of women veterans cared for at all U.S. Veterans Health Administration centers between the start of 2000 and the end of 2017. They identified nearly 130,000 female veterans with PTSD and nearly 260,000 without the mental health condition. Women with a heart disease diagnosis before or within 90 days of the initial study-related visit were excluded from analysis. Records for annual exams, emergency room visits and other exams or hospitalizations were assessed for new diagnoses of coronary artery disease, angina or heart attacks.

Ebrahimi noted they found:

• Women with PTSD had a 44% higher risk of developing ischemic heart disease compared to those without PTSD.
• The increased risk was most prominent in younger women, especially those younger than 40 years old (72%).
• The increased heart disease risk among women veterans with PTSD was also higher in racial and ethnic minorities, including Black women, non-white women from other racial backgrounds and women of Hispanic and Latina ethnicity, compared with white, female veterans.

"We were surprised by the magnitude of increased risk associated with PTSD in younger women, as current national guidelines do not recommend routine screening for cardiovascular disorders in women until the age of 45," Ebrahimi said. "Our results suggest that health care professionals should consider more routine and earlier screening for cardiovascular disorders in women with PTSD."