From the Fundación Jiménez Díaz, Avda, Reyes Católicos, Madrid, Spain (Vidal, Polo); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Alvarez, Falgas-Bague, Wang, Alegría); Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Lê Cook); and Department of Psychiatry, Harvard Medical School (Lê Cook), Departments of Medicine and Psychiatry, Harvard Medical School, Boston, Massachusetts (Alegría).
Psychosom Med. 2018 Sep;80(7):680-688. doi: 10.1097/PSY.0000000000000601.
Trauma and/or symptoms of posttraumatic stress disorder (PTSD) have been linked to the onset of cardiovascular disease (CVD), but the exact mechanism has not been determined. We examine whether the risk of CVD is different among those who have a history of trauma without PTSD symptoms, those who have experienced trauma and developed any symptoms of PTSD, and those with a PTSD diagnosis. Furthermore, we examine whether this association varies across ethnic/racial groups.
We used two data sets that form part of the Collaborative Psychiatric Epidemiology Surveys - the National Latino and Asian American Study and the National Comorbidity Survey Replication.
We found an increased likelihood of cardiovascular events for those with a diagnosis of PTSD (odds ratio [OR] = 2.10, 95% CI = 1.32-3.33) when compared with those who had not experienced trauma. We did not find an increased risk for those who had experienced trauma without symptoms or with subclinical symptoms of PTSD. The higher likelihood of having a cardiovascular event in those with PTSD was significant for non-Latino whites (OR = 1.86, 95% CI = 1.08-3.11), Latinos (OR = 1.94, 95% CI = 1.04-3.62), and non-Latino blacks (OR = 3.73, 95% CI = 1.76-7.91), but not for Asian respondents.
The constellation of symptoms defining PTSD diagnosis reflect adverse reactions to traumatic events and indicate that complex responses to traumatic events may be a risk factor for CVD.
创伤和/或创伤后应激障碍(PTSD)的症状与心血管疾病(CVD)的发生有关,但确切的机制尚未确定。我们研究了有创伤但无 PTSD 症状史、有创伤且出现任何 PTSD 症状史以及 PTSD 诊断史的人群,其 CVD 风险是否不同。此外,我们还研究了这种关联在不同族裔/种族群体中是否存在差异。
我们使用了两个构成合作性精神流行病学调查(CPES)的数据集,即全国拉丁裔和亚裔美国人研究(NALSA)和全国共病调查再测(NCS-R)。
与未经历创伤的人群相比,患有 PTSD 诊断的人群发生心血管事件的可能性更高(比值比 [OR] = 2.10,95%置信区间 [CI] = 1.32-3.33)。我们没有发现无创伤或 PTSD 亚临床症状史的人群有更高的风险。在 PTSD 患者中,发生心血管事件的可能性更高,这在非拉丁裔白人(OR = 1.86,95% CI = 1.08-3.11)、拉丁裔(OR = 1.94,95% CI = 1.04-3.62)和非拉丁裔黑人(OR = 3.73,95% CI = 1.76-7.91)中具有统计学意义,但在亚裔受访者中则没有。
定义 PTSD 诊断的症状组合反映了对创伤事件的不良反应,并表明对创伤事件的复杂反应可能是 CVD 的一个风险因素。