Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans
Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans
复制标题
女性退伍军人创伤后应激障碍与缺血性心脏病的关系
DOI：
10.1001/jamacardio.2021.0227
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发表时间：
2021-03-17
期刊：
影响因子：
24
通讯作者：
Sumner, Jennifer A.
中科院分区：
文献类型：
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作者：
Ebrahimi, Ramin;Lynch, Kristine E.;Sumner, Jennifer A.
问题 女性退伍军人中，先前诊断出的创伤后应激障碍 (PTSD) 与缺血性心脏病 (IHD) 相关吗？结果 在这项针对 398 769 名女性退伍军人的纵向队列研究中，其中 132 923 名患有 PTSD 的女性与 265 846 名没有 PTSD 的女性退伍军人（其中 132 923 名患有 PTSD）以 1:2 的比例进行匹配，患有 PTSD 的女性退伍军人发生 IHD 的几率要高出 44%。倾向评分匹配用于解释各种危险因素，包括传统和女性特有的心血管危险因素以及精神和身体健康障碍。意义 这些研究结果表明，PTSD 与女性退伍军人中发生 IHD 的风险增加相关。 这项纵向队列研究评估了美国女退伍军人中创伤后应激障碍是否与缺血性心脏病事件相关。 重要性 在以男性为主的人群或有限的社区样本中，创伤后应激障碍 (PTSD) 与缺血性心脏病 (IHD) 的较高风险相关。女性退伍军人代表了一个不断增长但尚未得到充分研究的群体，她们遭受高程度的创伤，并具有独特的心血管风险，但缺乏针对这一群体的创伤后应激障碍 (PTSD) 和缺血性心脏病 (IHD) 的研究。目的 确定 PTSD 是否与女性退伍军人的 IHD 事件相关。设计、背景和参与者 在这项针对国家退伍军人健康管理局 (VHA) 电子病历的回顾性纵向队列研究中，测试了 PTSD 与 IHD 发病风险较高相关的先验假设。对 2000 年 1 月 1 日至 2017 年 12 月 31 日期间在 VHA 接受治疗的 18 岁或以上患有或不患有 PTSD 的女性退伍军人进行了研究资格评估。排除标准包括首次就诊后没有发生 VHA 临床病例、首次就诊时或之前诊断出 IHD、以及首次就诊后 90 天内诊断出 IHD。对初次就诊时的年龄、既往就诊次数、是否存在传统和女性特有的心血管危险因素以及精神和身体健康状况进行倾向评分匹配，以识别曾经诊断出患有 PTSD 的女性退伍军人，并将她们与从未诊断出患有 PTSD 的女性退伍军人以 1:2 的比例进行匹配。数据分析时间为 2018 年 10 月 1 日至 2020 年 10 月 30 日。暴露 PTSD，根据国际疾病分类第九版修订版 (ICD-9) 或国际疾病和相关健康问题统计分类第十版修订版 (ICD-10) 定义，来自住院或门诊患者的诊断代码。主要结果和措施 事件 IHD，定义为新发冠状动脉疾病、心绞痛或心肌梗死，基于住院或门诊患者的 ICD-9 和 ICD-10 诊断代码，和/或基于当前程序术语代码的冠状动脉干预。结果 分析中共有 398 769 名女性退伍军人，其中 132 923 名患有 PTSD，265 846 名从未诊断出患有 PTSD。基线平均 (SD) 年龄为 40.1 (12.2) 岁。在中位随访 4.9 年（四分位距，2.1-9.2）年期间，4381 名患有 PTSD 的女性 (3.3%) 和 5559 名对照个体 (2.1%) 发生了 IHD。在 Cox 比例风险模型中，PTSD 与发生 IHD 的风险显着相关（风险比 [HR]，1.44；95% CI，1.38-1.50）。二次分层分析表明，患有创伤后应激障碍 (PTSD) 的女性退伍军人年龄较小，发生 IHD 的风险更大。基线时年龄小于 40 岁的患者的效应量最大（HR，1.72；95% CI，1.55-1.93），并且随着年龄的增加单调下降（≥ 60 岁的 HR，1.24；95% CI，1.12-1.38）。结论和相关性 这项队列研究发现，PTSD 与女性退伍军人 IHD 风险增加相关，并且可能对弱势个体的 IHD 风险评估有影响。
Question Is a prior diagnosis of posttraumatic stress disorder (PTSD) associated with incident ischemic heart disease (IHD) in women veterans? Findings In this longitudinal cohort study of 398 769 women veterans, including 132 923 with PTSD matched 1:2 to 265 846 without PTSD, those with PTSD had a 44% higher rate of developing incident IHD. Propensity score matching was used to account for various risk factors, including traditional and female-specific cardiovascular risk factors and mental and physical health disorders. Meaning These findings suggest that PTSD is associated with an increased risk of developing incident IHD among women veterans.This longitudinal cohort study assesses whether posttraumatic stress disorder is associated with incident ischemic heart disease in US women veterans.Importance Posttraumatic stress disorder (PTSD) is associated with greater risk of ischemic heart disease (IHD) in predominantly male populations or limited community samples. Women veterans represent a growing, yet understudied, population with high levels of trauma exposure and unique cardiovascular risks, but research on PTSD and IHD in this group is lacking. Objective To determine whether PTSD is associated with incident IHD in women veterans. Design, Setting, and Participants In this retrospective, longitudinal cohort study of the national Veterans Health Administration (VHA) electronic medical records, the a priori hypothesis that PTSD would be associated with greater risk of IHD onset was tested. Women veterans 18 years or older with and without PTSD who were patients in the VHA from January 1, 2000, to December 31, 2017, were assessed for study eligibility. Exclusion criteria consisted of no VHA clinical encounters after the index visit, IHD diagnosis at or before the index visit, and IHD diagnosis within 90 days of the index visit. Propensity score matching on age at index visit, number of prior visits, and presence of traditional and female-specific cardiovascular risk factors and mental and physical health conditions was conducted to identify women veterans ever diagnosed with PTSD, who were matched in a 1:2 ratio to those never diagnosed with PTSD. Data were analyzed from October 1, 2018, to October 30, 2020. Exposures PTSD, defined by International Classification of Diseases, Ninth Revision (ICD-9), or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), diagnosis codes from inpatient or outpatient encounters. Main Outcomes and Measures Incident IHD, defined as new-onset coronary artery disease, angina, or myocardial infarction, based on ICD-9 and ICD-10 diagnosis codes from inpatient or outpatient encounters, and/or coronary interventions based on Current Procedural Terminology codes. Results A total of 398 769 women veterans, 132 923 with PTSD and 265 846 never diagnosed with PTSD, were included in the analysis. Baseline mean (SD) age was 40.1 (12.2) years. During median follow-up of 4.9 (interquartile range, 2.1-9.2) years, 4381 women with PTSD (3.3%) and 5559 control individuals (2.1%) developed incident IHD. In a Cox proportional hazards model, PTSD was significantly associated with greater risk of developing IHD (hazard ratio [HR], 1.44; 95% CI, 1.38-1.50). Secondary stratified analyses indicated that younger age identified women veterans with PTSD who were at greater risk of incident IHD. Effect sizes were largest for those younger than 40 years at baseline (HR, 1.72; 95% CI, 1.55-1.93) and decreased monotonically with increasing age (HR for >= 60 years, 1.24; 95% CI, 1.12-1.38). Conclusions and Relevance This cohort study found that PTSD was associated with increased risk of IHD in women veterans and may have implications for IHD risk assessment in vulnerable individuals.