Remch Molly, Laskaris Zoey, Flory Janine, Mora-McLaughlin Consuelo, Morabia Alfredo
Barry Commoner Center for Health and the Environment, Queens College, City University of New York (M.R., Z.L., A.M.).
University of North Carolina Gillings School Of Global Public Health, Chapel Hill (M.R.).
Circ Cardiovasc Qual Outcomes. 2018 Jul;11(7):e004572. doi: 10.1161/CIRCOUTCOMES.117.004572.
We sought to determine whether post-traumatic stress disorder (PTSD) is a risk factor for myocardial infarction (MI) and stroke, beyond the expected effects from recognized cardiovascular risk factors and depression.
World Trade Center-Heart is an observational prospective cohort study of 6481 blue-collar first responders nested within the World Trade Center Health Program in New York City. Baseline measures in 2012 and 2013 included blood pressure, weight and height, and blood lipids. PTSD, depression, smoking, and dust exposure during the 2001 cleanup were self-reported. During the 4-year follow-up, outcomes were assessed through (1) interview-based incident, nonfatal MI, and stroke, validated in medical charts (n=118); and (2) hospitalizations for MI and stroke for New York city and state residents (n=180). Prevalence of PTSD was 19.9% in men and 25.9% in women, that is, at least twice that of the general population. Cumulative incidence of MI or stroke was consistently larger for men or women with PTSD across follow-up. Adjusted hazard ratios (HRs) were 2.22 (95% confidence interval [CI], 1.30-3.82) for MI and 2.51 (95% CI, 1.39-4.57) for stroke. For pooled MI and stroke, adjusted HRs were 2.35 (95% CI, 1.57-3.52) in all and 1.88 (95% CI, 1.01-3.49) in men free of depression. Using hospitalization registry data, adjusted HRs were 2.17 (95% CI, 1.41-3.32) for MI; 3.01 (95% CI, 1.84-4.93) for stroke; and for pooled MI and stroke, the adjusted HR was 2.40 (95% CI, 1.73-3.34) in all, HR was 2.44 (95% CI, 1.05-5.55) in women, and adjusted HR was 2.27 (95% CI, 1.41-3.67) in men free of depression. World Trade Center dust exposure had no effect.
This cohort study confirms that PTSD is a risk factor for MI and stroke of similar magnitude in men and women, independent of depression.
我们试图确定创伤后应激障碍（PTSD）是否是心肌梗死（MI）和中风的危险因素，这一因素独立于公认的心血管危险因素和抑郁症所产生的预期影响之外。
世界贸易中心-心脏研究是一项前瞻性观察性队列研究，对纽约市世界贸易中心健康项目中的6481名蓝领急救人员进行了研究。2012年和2013年的基线测量包括血压、体重、身高和血脂。PTSD、抑郁症、吸烟情况以及2001年清理工作期间的粉尘暴露情况均通过自我报告获得。在4年的随访期间，通过以下方式评估结果：（1）基于访谈的新发非致命性心肌梗死和中风事件，在病历中得到验证（n = 118）；（2）纽约市和纽约州居民因心肌梗死和中风的住院情况（n = 180）。男性PTSD患病率为19.9%，女性为25.9%，即至少是普通人群的两倍。在整个随访过程中，患有PTSD的男性或女性发生心肌梗死或中风的累积发病率始终较高。心肌梗死的调整后风险比（HR）为2.22（95%置信区间[CI]，1.30 - 3.82），中风的调整后HR为2.51（95% CI，1.39 - 4.57）。对于合并的心肌梗死和中风，总体调整后HR为2.35（95% CI，1.57 - 3.52），无抑郁症的男性调整后HR为1.88（95% CI，1.01 - 3.49）。使用住院登记数据，心肌梗死的调整后HR为2.17（95% CI，1.41 - 3.32）；中风的调整后HR为3.01（95% CI，1.84 - 4.93）；对于合并的心肌梗死和中风，总体调整后HR为2.40（95% CI，1.73 - 3.34），女性调整后HR为2.44（95% CI，1.05 - 5.55），无抑郁症的男性调整后HR为2.27（95% CI，1.41 - 3.67）。世界贸易中心粉尘暴露无影响。
这项队列研究证实，PTSD是男性和女性发生心肌梗死和中风的危险因素，且独立于抑郁症，其影响程度相似。
