Kubzansky Laura D, Koenen Karestan C, Spiro Avron, Vokonas Pantel S, Sparrow David
Harvard School of Public Health, Veterans Affairs Normative Aging Study, Veterans Affairs Boston Health Care System, Boston University School of Medicine, 677 Huntington Avenue, Boston, MA 02115, USA.
Arch Gen Psychiatry. 2007 Jan;64(1):109-16. doi: 10.1001/archpsyc.64.1.109.
Various correlates of posttraumatic stress disorder (PTSD), such as high levels of sympathetic activation and hypothalamic-pituitary-adrenal axis dysregulation, have been linked to arterial damage and coronary heart disease (CHD) risk. While psychological disturbance is frequently found among patients with cardiac disease, whether psychological problems precede or occur as a result of having a potentially fatal disease is not clear. To our knowledge, no prospective studies to date have evaluated whether PTSD is associated with increased risk of CHD.
To test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using 2 different measures of PTSD.
Prospective cohort study.
Community-dwelling men from the Greater Boston, Mass, area who served in the military.
Data are from the Veterans Affairs Normative Aging Study. Men who completed either the Mississippi Scale for Combat-Related PTSD in 1990 (n = 1002) or the Keane PTSD scale in 1986 (n = 944) were included in the study.
Incident CHD occurring during follow-up through May 2001.
Levels of PTSD symptoms in this cohort were low to moderate. Men with preexisting CHD at baseline were excluded, and PTSD was measured with the Mississippi Scale for Combat-Related PTSD. For each SD increase in symptom level, men had age-adjusted relative risks of 1.26 (95% confidence interval, 1.05-1.51) for nonfatal myocardial infarction and fatal CHD combined and 1.21 (95% confidence interval, 1.05-1.41) for all of the CHD outcomes combined (nonfatal myocardial infarction, fatal CHD, and angina). Findings were replicated using the Keane PTSD scale and somewhat strengthened after controlling for levels of depressive symptoms.
To our knowledge, this is the first study to demonstrate a prospective association between PTSD symptoms and CHD even after controlling for depressive symptoms. These results suggest that a higher level of PTSD symptoms may increase the risk of incident CHD in older men.
创伤后应激障碍（PTSD）的各种相关因素，如高水平的交感神经激活和下丘脑 - 垂体 - 肾上腺轴失调，已与动脉损伤和冠心病（CHD）风险相关联。虽然在心脏病患者中经常发现心理障碍，但心理问题是先于潜在致命疾病出现还是因患潜在致命疾病而产生尚不清楚。据我们所知，迄今为止尚无前瞻性研究评估PTSD是否与冠心病风险增加相关。
使用两种不同的PTSD测量方法来检验高水平的PTSD症状可能增加冠心病风险这一假设。
前瞻性队列研究。
马萨诸塞州大波士顿地区居住在社区的退伍军人。
数据来自退伍军人事务部规范老化研究。纳入研究的男性为1990年完成密西西比与战斗相关PTSD量表（n = 1002）或1986年完成基恩PTSD量表（n = 944）的人。
截至2001年5月随访期间发生的冠心病事件。
该队列中的PTSD症状水平为低至中度。排除基线时已患有冠心病的男性，并使用密西西比与战斗相关PTSD量表测量PTSD。症状水平每增加一个标准差，男性非致命性心肌梗死和致命性冠心病合并的年龄调整相对风险为1.26（95%置信区间，1.05 - 1.51），所有冠心病结局（非致命性心肌梗死、致命性冠心病和心绞痛）合并的年龄调整相对风险为1.21（95%置信区间，1.05 - 1.41）。使用基恩PTSD量表重复了这些发现，并且在控制抑郁症状水平后有所加强。
据我们所知，这是第一项即使在控制抑郁症状后仍证明PTSD症状与冠心病之间存在前瞻性关联的研究。这些结果表明，较高水平的PTSD症状可能会增加老年男性发生冠心病的风险。
