Twin male Vietnam war veterans with post-traumatic stress disorder (PTSD) were at double the risk to develop heart disease compared with those without PTSD, according to new research supported by the National Institutes of Health.

The current study is the first long-term analysis that examined the link between heart disease and PTSD using objective clinical diagnoses with cardiac imaging techniques, its findings were published in the Journal of the American College of Cardiology.

Gary H. Gibbons, M.D., director of the NIH’s National Heart, Lung, and Blood Institute (NHLBI), which partially funded the study, explained:

“This study provides further evidence that PTSD may affect physical health. Future research to clarify the mechanisms underlying the link between PTSD and heart disease in Vietnam veterans and other groups will help to guide the development of effective prevention and treatment strategies for people with these serious conditions.”

A team of investigators from Emory University Rollins School of Public Health in Atlanta evaluated the incidence of heart disease in 562 middle-aged twins (222 fraternal and 340 identical) from the Vietnam Era Twin Registry.

The prevalence of heart disease was 22.6% in twins with PTSD (177 people) and 8.9% in individuals without PTSD (425 people). Heart disease was described as:

  • having a heart attack
  • having an overnight hospital stay for heart-related symptoms
  • or having undergone a heart operation

Nuclear scans were used to take images of blood flow to the heart and revealed that people with PTSD had close to twice as many areas of decreased blood flow to the heart as people without PTSD.

With the use of twins, the researchers were able to control for the impact of genes and environment on the development of PTSD and heart disease.

Lead researcher Viola Vaccarino, M.D., Ph.D., professor in the department of medicine at Emory University and chair of the department of epidemiology at the Rollins School of Public Health, said:

“This study suggests a link between PTSD and cardiovascular health. For example, repeated emotional triggers during everyday life in persons with PTSD could affect the heart by causing frequent increases in blood pressure, heart rate, and heartbeat rhythm abnormalities that in susceptible individuals could lead to a heart attack.”

Researchers compared the 234 twins where one had PTSD and one did not, finding that the prevalence of heart disease was nearly double in those individuals with PTSD compared to those without the disorder (22.2% vs 12.8%).

The outcomes of PTSD on heart disease stayed consistent even after researchers controlled for lifestyle factors like drinking, physical activity level, and smoking, as well as depression and other psychiatric diagnoses.

No link was seen between PTSD and well-documented heart disease risk factors like obesity, diabetes or hypertension, implying that the disease may be caused by physiologic changes and not lifestyle factors.

PTSD affects close to 7.7 million American adults and is an anxiety disorder that develops in a small number of people after they experience severe psychological trauma-like, life-threatening or frightening events. Persistent scary thoughts and memories of their trauma may continue, and they can experience symptoms such as:

  • sleep problems
  • be easily startled
  • feel detached

A previous study published in the American Journal of Cardiology suggested that all people with PTSD are at a higher risk of developing heart disease and dying prematurely.

A 2006 analysis of military data from the National Vietnam Veterans Readjustment Study established that between 15% and 19% of Vietnam veterans have experienced PTSD at some point after their war tour.

Also released today was a report by the European Heart Journal, that suggested anticipating that you are unhealthy because of stress could have a negative impact on your heart health.

Written by Kelly Fitzgerald