Department of Family and Community Medicine, Saint Louis University School of Medicine.
National Center for PTSD.
Health Psychol. 2020 May;39(5):403-412. doi: 10.1037/hea0000855. Epub 2020 Mar 30.
Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiometabolic disease. Clinically meaningful PTSD improvement is associated with a lower risk for diabetes, but it is not known if similar associations exist for incident hypertension, hyperlipidemia, and clinically relevant weight loss (i.e., ≥5% loss).
Medical record data from Veterans Health Affairs patients with clinic encounters between fiscal year (FY) 2008 to 2015 were used to identify patients with worsening or no PTSD improvement (i.e., PTSD checklist (PCL) score decrease <10), small (10-19 point PCL decrease), and large (≥20 point PCL decrease) PTSD improvement. To estimate the association between degree of PTSD improvement and incident hypertension (n = 979), incident hyperlipidemia (n = 1,139) and incident ≥5% weight loss (1,330), we computed Cox proportional hazard models, controlling for confounding using inverse probability of exposure weighting (IPEW).
Overall, patients were about 40 years of age, 80% male and 65% White. Worsening or no PCL change occurred in about 60%, small improvement in 20%, and large improvement in 20%. After weighting data, compared with worsening or no change, both small and large PTSD improvements were associated, albeit not significantly, with lower risks for hypertension (HR = 0.68; 95% confidence interval, CI [0.46, 1.01] and HR = 0.79; 95% CI [0.53, 1.18], respectively). In weighted data, PTSD improvement was not associated with incident hyperlipidemia or ≥5% weight loss.
We observed limited evidence for an association between PTSD improvement and decreased hypertension risk. PCL decreases were not associated with hyperlipidemia or ≥5% weight loss. Further studies that measure potential physical health benefits of change in specific PTSD symptoms are needed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
创伤后应激障碍（PTSD）与心血管代谢疾病的风险增加有关。临床上有意义的 PTSD 改善与糖尿病风险降低相关，但尚不清楚是否存在类似的关联，如高血压、血脂异常和临床相关的体重减轻（即体重减轻≥5%）。
利用退伍军人事务部患者在 2008 财年至 2015 年期间的就诊记录数据，识别 PTSD 恶化或无改善（即 PTSD 检查表（PCL）评分降低<10）、较小（PCL 降低 10-19 分）和较大（PCL 降低≥20 分）改善的患者。为了评估 PTSD 改善程度与高血压（n=979）、血脂异常（n=1139）和体重减轻≥5%（n=1330）发生率之间的关联，我们计算了 Cox 比例风险模型，使用逆概率暴露加权（IPEW）控制混杂因素。
总体而言，患者年龄约为 40 岁，80%为男性，65%为白人。约 60%的患者 PC 变化恶化或无变化，20%的患者 PC 变化较小，20%的患者 PC 变化较大。在数据加权后，与恶化或无变化相比，较小和较大 PTSD 改善与高血压风险降低相关，尽管没有统计学意义（HR=0.68；95%置信区间[0.46，1.01]和 HR=0.79；95%置信区间[0.53，1.18]）。在加权数据中，PTSD 改善与血脂异常或体重减轻≥5%无关。
我们观察到 PTSD 改善与降低高血压风险之间存在有限的关联证据。PCL 降低与血脂异常或体重减轻≥5%无关。需要进一步研究，以衡量 PTSD 特定症状变化对身体健康的潜在益处。
