Stress disorders tied to increased heart disease risk

People who suffer from conditions like post-traumatic stress disorder (PTSD) may be more likely to develop cardiovascular disease, a Swedish study suggests, and the risk may be greatest in the months right after stress disorders are diagnosed. 

For the study, researchers examined data on 136,637 people diagnosed with PTSD, acute stress reaction, adjustment disorder or other mental health problems caused by stressful or traumatic events. They also looked at data for 171,314 siblings of these patients who were not exposed to stressful or traumatic events as well as almost 1.4 million other individuals without such exposure. 

None of the subjects had cardiovascular disease at the start of the study period. 

During 27 years of follow-up, researchers calculated what proportion of people in each group developed cardiovascular diseases every year. Among those with stress disorders, an average of 10.5 people per 1,000 were diagnosed each year with atherosclerosis, arrhythmias, embolisms, high blood pressure, strokes, heart attacks and other cardiovascular conditions. That compares with an average of 8.4 per 1,000 among their siblings and 6.9 per 1,000 in the wider population without stress disorders. 

“The large majority of humans are at some point in their lives exposed to trauma or stressful life events, with a significant proportion developing severe psychiatric reactions such as PTSD or adjustment disorder,” said lead study author Huan Song of the University of Iceland in Reykjavik and the Karolinska Institutet in Stockholm. 

“Medical providers should be aware that these vulnerable populations may suffer heightened risks of various cardiovascular diseases, which calls for enhanced clinical awareness/monitoring and, perhaps, early intervention among patients with recently diagnosed stress-related disorders,” Song said by e-mail. 

The risk of severe and acute cardiovascular events, such as cardiac arrest and heart attack, was particularly high in the first six months after diagnosis of a stress disorder, and within the first year for other types of cardiovascular diseases, researchers report in The BMJ. 

And, there was a stronger link between stress disorders and cases of cardiovascular disease that developed earlier in life, before age 50, than for cases diagnosed later, the study found. 

The study was not designed to prove whether or how stress disorders might directly cause cardiovascular disease. 

While researchers did account for several factors that can contribute to cardiovascular disease like family background, medical history and underlying psychiatric conditions, it is still possible that some unmeasured stress-coping behaviours like smoking and drinking might have also influenced the results, the authors note. 

It is also unclear how treating stress disorders or underlying psychiatric issues might impact the chances of developing cardiovascular problems. 

“The evidence we have to date doesn’t show that treating psychological problems leads to reductions in heart disease,” said the author of an accompanying editorial, Simon Bacon of Concordia University in Montreal. 

“However, there are very few of these studies and there are some problems with the studies, so it is still possible that the right kind of treatments might actually reduce PTSD and the chances of developing heart disease,” Bacon said by e-mail. 

But patients should still seek medical attention if they feel like stress is affecting their physical or mental health, Bacon advised. 

“There are some really good treatments for these kinds of disorders and no one should suffer unnecessarily,” Bacon said. “It is also possible that by treating these disorders, the person might not only improve their mental health but also their physical health.”