Posttraumatic stress disorder and risk of cardiovascular disease

Abstract

PTSD is a disabling mental disorder with health consequences that reach far beyond the neuropsychiatric domain. Growing evidence links PTSD to increased risk of cardiovascular conditions including ischemic heart disease and thromboembolic stroke. Emerging data also suggest that PTSD may be a consequence, in addition to a cause, of acute, life-threatening cardiovascular events. Individuals with PTSD are more likely to engage in adverse lifestyle behaviors, which may predispose to cardiovascular risk factors such as obesity, diabetes, and hypertension. PTSD is also frequently comorbid with other psychiatric conditions which may affect cardiovascular risk, such as depression and substance abuse. However, additional plausible mechanisms exist that go beyond these associated conditions and risk factors. An emerging model of cardiovascular risk in PTSD is that neurobiology plays a role. Specifically, mechanisms such as repeated and heightened physiological activation in association with intrusive memories in PTSD could lead to cumulative long-term damaging effects on the cardiovascular system. This could be mediated through vascular, immune, or other mechanisms. This chapter will review the existing evidence linking PTSD to major cardiovascular disorders, discuss potential underlying pathophysiology, and provide suggestions for future research.