Impact of PTSD on cardiovascular risk in survivors of stroke and transient ischemic attack

 描述（由申请人提供）：本研究的目的是确定卒中或短暂性脑缺血发作（TIA）后干预的新靶点，可降低后续心血管事件和死亡率的风险。随着医疗保健的进步，大多数因中风和TIA住院的患者都能存活下来。然而，这些患者的复发性心血管事件和死亡率的风险仍然显著升高。可能导致这种风险的一种现象是中风/TIA引起的创伤后应激障碍（PTSD）。一些小型研究表明，中风或短暂性脑缺血发作的经历可能是一种心理创伤事件，会诱发创伤后应激障碍。对其他类型的创伤事件引起的PTSD的研究表明，PTSD不仅导致心理健康状况不佳，而且还可能对心血管风险产生不利影响。PTSD可能增加这种风险的一个行为途径是不坚持二级预防药物。事实上，PTSD的概念模型表明，中风/TIA幸存者可能会避免心血管药物，因为它们会提醒创伤性中风/TIA事件。然而，到目前为止，很少有小型研究评估中风和TIA幸存者的PTSD，也没有评估中风/TIA诱导的PTSD是否影响预后或药物依从性是否介导了这种关联。本研究的第一个目的是在多种族人群中确定卒中/TIA后第一年卒中/TIA诱导的PTSD症状的患病率和预测因素。研究的第二个目的是确定卒中/TIA诱导的PTSD是否会增加心血管事件的风险和1年的死亡率。本研究的第三个目的是确定卒中/TIA诱导的PTSD对二级预防药物依从性的影响，并探讨药物不依从性是否部分解释了PTSD与1年预后的任何关联。为了实现这些目标，我们建议从急诊科（艾德）招募1,000名轻中度卒中和TIA患者，为不同的患者人群提供服务。我们将评估患者在艾德和住院期间对卒中/TIA的心理反应。我们将在医院和1个月，6个月和1年后评估PTSD。我们还将使用最先进的无线电子药瓶评估卒中/TIA后前6个月二级预防药物的依从性。最后，我们将记录1年内复发的心血管事件和死亡率。中风是美国第四大死亡原因，也是导致严重长期残疾的主要原因。 美国每年有330万门诊病人和近100万住院病人是由于中风。确定卒中/TIA诱导的PTSD的患病率及其与不良预后和药物依从性的相关性，以及识别PTSD风险因素是必要的，因为这些信息可能会产生筛选和/或治疗目标，然后可以在未来的随机试验中进行测试，以改善卒中和TIA幸存者的医疗和心理预后。

 DESCRIPTION (provided by applicant): The goal of this study is to identify a novel target for intervention after stroke or transient ischemic attack (TIA) that may decrease risk for subsequent cardiovascular events and mortality. With advances in healthcare, most patients hospitalized for stroke and TIA survive. However, these patients remain at markedly elevated risk for recurrent cardiovascular events and mortality. One phenomenon that may contribute to this risk is stroke/TIA induced posttraumatic stress disorder (PTSD). Several small studies have shown that the experience of a stroke or TIA can be a psychologically traumatic event that induces PTSD. Studies of PTSD induced by other types of traumatic events suggest that PTSD not only contributes to poor mental health, but can also adversely affect cardiovascular risk. One behavioral pathway by which PTSD may increase this risk is through non-adherence to secondary prevention medications. Indeed, conceptual models of PTSD suggest that stroke/TIA survivors may avoid cardiovascular medications because they serve as reminders of the traumatic stroke/TIA event. Thus far, however, few small studies have assessed PTSD in stroke and TIA survivors, and none have assessed whether stroke/TIA-induced PTSD influences prognosis or whether medication adherence mediates this association. The first aim of the study is to determine the prevalence and predictors of stroke/TIA-induced PTSD symptoms throughout the first year post-stroke/TIA in a multi-ethnic population. The second aim of the study is to determine whether stroke/TIA-induced PTSD increases risk for cardiovascular events and mortality at 1 year. The third aim of the study is to determine the influence of stroke/TIA-induced PTSD on adherence to secondary prevention medications, and to explore whether medication non-adherence partially explains any association of PTSD with 1-year prognosis. To accomplish these aims, we propose to enroll a cohort of 1,000 mild-moderate stroke and TIA patients from the emergency department (ED) serving a diverse patient population. We will assess patients' psychological reactions to the stroke/TIA while they are in the ED and during their inpatient stay. We will assess PTSD in-hospital and 1 month, 6 months, and 1 year later. We will also assess adherence to secondary prevention medications in the first 6 months after stroke/TIA using state-of-the-art wireless electronic pill bottles. Finally, we will record recurret cardiovascular events and mortality across 1 year. Stroke is the fourth leading cause of death and the leading cause of serious long-term disability in the U.S. More than 7 million adults in the U.S. alone are stroke survivors, and each year 3.3 million ambulatory care visits and nearly 1 million inpatient admissions are due to stroke. Determining the prevalence of stroke/TIA-induced PTSD and its association with poor prognosis and medication adherence, as well as identifying PTSD risk factors are necessary, as this information may yield screening and/or treatment targets that can then be tested in future randomized trials to improve medical and psychological prognosis in stroke and TIA survivors.