Posttraumatic Stress Disorder Is Associated With Elevated Risk of Incident Stroke and Transient Ischemic Attack in Women Veterans

Author:

Ebrahimi Ramin12ORCID,Dennis Paul A.34ORCID,Alvarez Carlos A.56ORCID,Shroyer A. Laurie78ORCID,Beckham Jean C.49ORCID,Sumner Jennifer A.10ORCID

Affiliation:

1. Department of Medicine University of California Los Angeles CA USA

2. Department of Medicine Veterans Affairs (VA) Greater Los Angeles Healthcare System Los Angeles CA USA

3. Department of Population Health Sciences Duke University School of Medicine Durham NC USA

4. Durham VA Medical Center Durham NC USA

5. Department of Pharmacy Practice Texas Tech University Health Science Center Lubbock TX USA

6. Department of Research VA North Texas Health Care System Dallas TX USA

7. Department of Surgery, Renaissance School of Medicine Stony Brook University Stony Brook NY USA

8. Northport VA Medical Center Northport NY USA

9. Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham NC USA

10. Department of Psychology University of California Los Angeles CA USA

Abstract

Background Posttraumatic stress disorder (PTSD) has been associated with ischemic heart disease in women veterans, but evidence for associations with other cardiovascular disorders remains limited in this population. This retrospective longitudinal cohort study evaluated the association of PTSD with incident stroke/transient ischemic attack (TIA) in women veterans. Methods and Results Veterans Health Administration electronic health records were used to identify women veterans aged ≥18 years engaged with Veterans Health Administration health care from January 1, 2000 to December 31, 2019. We identified women veterans with and without PTSD without a history of stroke or TIA at start of follow‐up. Propensity score matching was used to match groups on age, race or ethnicity, traditional cardiovascular risk factors, female‐specific risk factors, a range of mental and physical health conditions, and number of prior health care visits. PTSD, stroke, TIA, and risk factors used in propensity score matching were based on diagnostic codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for associations of PTSD with an incident stroke/TIA composite. Subanalyses considered stroke and TIA separately, plus age‐ and race‐ or ethnicity‐stratified analyses were carried out. The analytic sample included 208 092 women veterans (104 046 with and 104 046 without PTSD). PTSD was associated with a greater rate of developing stroke/TIA (HR, 1.33 [95% CI, 1.25–1.42], P <0.001). This elevated risk was especially pronounced in women <50 years old and in Hispanic/Latina women. Conclusions Findings indicate a strong association of PTSD with incident stroke/TIA in women veterans. Research is needed to determine whether addressing PTSD and its downstream consequences can offset this risk.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference59 articles.

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3. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

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