Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review.
Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review.
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DOI：
10.1016/j.ahj.2013.07.031
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发表时间：
2013-11
影响因子：
4.8
通讯作者：
Burg MM
中科院分区：
文献类型：
--
作者：
Edmondson D;Kronish IM;Shaffer JA;Falzon L;Burg MM
评估创伤后应激障碍（PTSD）与冠心病（CHD）发病风险的关联
系统综述与荟萃分析
Ovid MEDLINE、PsycINFO、Scopus、Cochrane图书馆、PILOTS数据库、PubMed相关文献以及手动检索参考文献列表（1948年至今）
纳入所有对初始无冠心病的参与者进行PTSD评估，随后评估冠心病/心脏特异性死亡率的研究。
两名研究者独立提取PTSD与冠心病关联的估计值以及研究特征。优势比转换为风险比（HR），并使用随机效应模型汇总结果。进行了一项二次分析，仅包括报告了针对抑郁症进行调整后的估计值的研究。
六项研究符合我们的纳入标准（N = 402274）；其中五项将抑郁症作为协变量。在对抑郁症进行调整之前，PTSD与冠心病之间关系程度的汇总风险比为1.55（95%置信区间，1.34 - 1.79）。五项针对抑郁症进行调整后的估计值（N = 362950）的汇总风险比估计值为1.27（95%置信区间，1.08 - 1.49）。
即使在对抑郁症和其他协变量进行调整后，PTSD仍与冠心病发病风险增加独立相关。PTSD在退伍军人和平民创伤幸存者中都很常见，这些结果表明它可能是冠心病的一个可改变的风险因素。未来的研究应确定这种关联的机制，并确定PTSD治疗是否能抵消冠心病风险。
To estimate the association of posttraumatic stress disorder (PTSD) with risk for incident coronary heart disease (CHD) Systematic review and meta-analysis Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, PubMed Related Articles, and a manual search of reference lists (1948-present) All studies that assessed PTSD in participants initially free of CHD and subsequently assessed CHD/cardiac-specific mortality were included. Two investigators independently extracted estimates of the association of PTSD to CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HR), and a random-effects model was used to pool results. A secondary analysis including only studies that reported estimates adjusted for depression was conducted. Six studies met our inclusion criteria (N= 402,274); 5 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.55 (95% CI, 1.34–1.79) before adjustment for depression. The pooled HR estimate for the 5 depression-adjusted estimates (N= 362,950) was 1.27 (95% CI, 1.08–1.49). PTSD is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. PTSD is common in both military veterans and civilian trauma survivors, and these results suggest that it may be a modifiable risk factor for CHD. Future research should identify mechanisms of this association and determine whether PTSD treatment offsets CHD risk.