Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
J Affect Disord. 2021 Mar 1;282:712-716. doi: 10.1016/j.jad.2020.12.180. Epub 2020 Dec 30.
Posttraumatic stress disorder is a well-documented risk factor for cardiovascular disease. Whether non-specific stress-related psychopathology also increases risk is less well known.
In a cohort of adult Danish-born residents of Denmark with an incident diagnosis of unspecified reaction to severe stress ("unspecified stress reaction") between 1995 and 2011 (N = 24,534), we assessed incidence of seven arterial and venous cardiovascular events/conditions between 1996 and 2013. We calculated standardized incidence ratios (SIRs) comparing incidence of each outcome among the cohort to expected incidence based on sex-, age-, and calendar-time-specific national rates. We conducted stratified analyses by demographic characteristics, comorbidities, and length of follow-up time.
Incidence over the study period ranged from 1.1% for provoked VTE to 5.7% for stroke, adjusting for competing risk of death. Unspecified stress reaction was associated with all outcomes (SIRs ranging from 1.3, 95% confidence interval (CI): 1.1-1.4 for atrial fibrillation/flutter to 1.9, 95% CI: 1.7-2.2 for unprovoked VTE and 1.9, 95% CI: 1.6-2.3 for provoked VTE). Associations persisted, but were attenuated, when restricting to persons without alcohol use disorder and to persons without physical health comorbidities.
Unspecified stress reaction has less precise criteria than other stress-related diagnoses, and we could not adjust for some potential confounders.
Our results augment literature on stress disorders and cardiovascular disease by highlighting the additional importance of unspecified stress disorders. Further research on this diagnostic category, which may represent subsyndromal psychopathology, is warranted. These findings support considering persons with non-specific stress-related psychopathology in treatment and tertiary prevention activities.
创伤后应激障碍是心血管疾病的一个有据可查的危险因素。非特异性应激相关精神病理学是否也会增加风险则知之甚少。
在丹麦一项队列研究中，纳入了在 1995 年至 2011 年间患有未特指的严重应激反应（“未特指的应激反应”）的丹麦出生的成年居民，共 24534 例，评估了 1996 年至 2013 年期间 7 种动静脉心血管事件/疾病的发病率。我们计算了标准化发病比（SIR），比较了队列中每种结局的发生率与基于性别、年龄和日历时间的特定国家发病率的预期发生率。我们根据人口统计学特征、合并症和随访时间进行了分层分析。
在研究期间，发病率从 1.1%（有诱因的静脉血栓栓塞症）到 5.7%（中风）不等，同时考虑了死亡的竞争风险。未特指的应激反应与所有结局相关（SIR 范围为 1.3，95%置信区间[CI]：1.1-1.4，用于心房颤动/扑动；1.9，95%CI：1.7-2.2，用于无诱因静脉血栓栓塞症；1.9，95%CI：1.6-2.3，用于有诱因静脉血栓栓塞症）。当限制在没有酒精使用障碍和没有身体健康合并症的人群中时，关联仍然存在，但有所减弱。
未特指的应激反应的标准比其他应激相关的诊断更不精确，我们无法调整一些潜在的混杂因素。
我们的研究结果通过强调未特指的应激障碍的额外重要性，增加了应激障碍与心血管疾病的文献。需要进一步研究这一诊断类别，这可能代表亚综合征精神病理学。这些发现支持在治疗和三级预防活动中考虑有非特异性应激相关精神病理学的患者。
