Association of PTSD dose with cardiovascular disease risk in multi-ethnic WTC Heart Cohort: 13 year follow up

背景：创伤后应激障碍(PTSD)的治疗可能有助于预防心血管疾病(CVD，) 这是导致死亡的主要原因。创伤后应激障碍治疗与安慰剂疗效的随机对照试验 关于心血管疾病风险的研究将无法评估创伤后应激障碍症状持续时间(“剂量”)与心血管疾病风险(例如冠心病)的关系 发病率和死亡率)，而不是病理生理标记物，考虑到研究持续时间和样本量 需要的。在这里，我们建议收集数据来补充理想试验的结果--即使用观察性的 适当和高效的数据-通过使用我们跟踪时间变化的症状的纵向研究 创伤后应激障碍、随时间变化的传统心血管疾病危险因素，以及心血管疾病的发病率和死亡率。多种多样- 种族WTC-心脏队列研究将伴随着一项子研究，评估是否如假设的那样，患有 创伤后应激障碍的剂量越小，暴露于应激、创伤和心血管危险因素的标记物就越少。前期工作：1.a 2012-2013年对6481名具有长期随访和高保留率的急救人员的队列研究 WTC-心脏在WTC健康计划(WTCHP)中招募了6481名急救人员，以评估 队列成员报告并在病历中确认的心血管事件病例，以及事件住院 来自纽约州住院登记处(SPARCS)。截至2016年，留存率为91%。2.纵向评估 PSTD症状和常规心血管疾病危险因素：队列成员在#年曾到WTCHP就诊多达15次 对患者的心理健康状况和心脑血管疾病相关因素进行评估。3.不同的性别和种族/族裔构成：队列 包括17%的女性和54%的非西班牙裔白人。具体目标：目标1。要进行第二次面对面， 在2022-23年对WTC-心脏队列进行标准化评估，并跟踪到2026年，利用 13-14年随访的统计力量，创伤后应激障碍的高患病率，与国家死亡的联系 索引。目的2.评估创伤后应激障碍(PTSD)剂量的因果效应及其对总(致命性和非致命性)和 非致命性心血管疾病、冠状动脉疾病和脑血管疾病，总体上和种族(非西班牙裔白人， 非西班牙裔黑人和西班牙裔)群体。分析将使用2012年间对创伤后应激障碍和心血管疾病的重复评估 和2026年，并对及时更新的心血管疾病风险因素和新冠肺炎暴露进行适当调整，使用G- 方法：研究方法。目的3.评估流行病学的生物学、行为和创伤病史的可信性 通过测量慢性应激的生物学指标、创伤病史、 以及在创伤后应激障碍剂量范围内随机招募的240名参与者中的心血管疾病危险因素。 创新和意义：如果拟议的研究具有潜在的重大临床和公共卫生意义 有助于确定：1)心血管疾病发病率和死亡率的风险是否与创伤后应激障碍剂量成反比；2)第一 WTCHP的应答者有权接受心血管疾病筛查和护理。

Background: Treatment of post-traumatic stress disorder (PTSD) may help prevent cardiovascular diseases (CVD,) which is a leading cause of death. Randomized controlled trials comparing the effect of PTSD treatment vs. placebo on CVD risk would be unable to assess the relation of duration of PTSD symptoms (“dose”) to CVD risk (e.g., CHD morbidity and mortality) rather than pathophysiological markers, given the duration of study and sample size needed. Here, we propose to collect data to complement the results of the ideal trial – that is, to use observational data appropriately and efficiently – by making use of our longitudinal study tracking the time-varying symptoms of PTSD, time-varying conventional CVD risk factors and, as outcome, incidence and mortality from CVD. The multi- ethnic WTC-Heart cohort study will be accompanied by a sub-study assessing whether, as assumed, individuals with lower PTSD dose have lower exposure to markers of stress, trauma, and CVD risk factors. Preliminary work: 1. A cohort study of initially 6481 first responders with a long term follow up and high retention rate: In 2012-2013 WTC-Heart enrolled 6481 first-responders in the WTC Health Program (WTCHP) to assess the determinants of incident cases of CVD reported by cohort members and validated in medical charts, and incident hospitalizations from the NY State hospitalization registry (SPARCS). Retention was 91% as of 2016. 2. Longitudinal assessment of PSTD symptoms and conventional CVD risk factors: The cohort members have had up to 15 visits at the WTCHP in which mental health and CVD factors were assessed. 3. A diverse gender and race/ethnic composition: the cohort comprises 17% of women and 54% Non-Hispanic Whites. Specific Aims: Aim 1. To perform a second in-person, standardized assessment in 2022-23 of the WTC-Heart cohort with follow-up until 2026, taking advantage of the statistical power resulting from 13-14 years of follow-up, high prevalence of PTSD, linkage with National Death Index. Aim 2. To estimate the causal effect of PTSD dose and its potential changes on total (fatal and non-fatal) and non-fatal CVD, coronary artery disease, and cerebrovascular diseases, overall and among ethnic (non-Hispanic white, non-Hispanic Black, and Hispanic) groups. Analyses will use repeated assessments of PTSD and CVD between 2012 and 2026, and appropriate adjustment for time-updating CVD risk factors, and for COVID-19 exposure, using G- methods. Aim 3. To assess the biological, behavioral and trauma history plausibility of the epidemiological associations between PTSD dose and CVD risk by measuring biological indicators of chronic stress, history of trauma, and CVD risk factor among a subsample of 240 participants randomly recruited within tertiles of PTSD dose. Innovation and Significance: The proposed study has a potentially major clinical and public health significance if it helps to determine whether: 1) risk of CVD morbidity and mortality is inversely related to PTSD dose; 2) first responders in the WTCHP are entitled to be covered for CVD screening and care.