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。比较PTSD治疗与安慰剂效果的随机对照试验 将无法评估PTSD症状的持续时间（“剂量”）与CVD风险的关系（例如，CHD 发病率和死亡率），而不是病理生理学标志物，考虑到研究的持续时间和样本量 needed.在这里，我们建议收集数据，以补充理想试验的结果-也就是说，使用观察 数据适当和有效地-通过利用我们的纵向研究跟踪随时间变化的症状， PTSD、随时间变化的常规CVD危险因素以及CVD的发病率和死亡率作为结局。多- 种族WTC-心脏队列研究将伴随一项子研究，评估是否如假设的那样， 较低的PTSD剂量具有较低的暴露于压力、创伤和CVD危险因素的标记物。前期工作：1。一 最初6481名第一应答者的队列研究，长期随访和高留存率：2012-2013年 WTC-Heart在WTC健康计划（WTCHP）中招募了6481名第一反应者，以评估 由队列成员报告并在病历中验证的CVD事件病例，以及事件住院 纽约州住院登记处（SPARCS）。截至2016年，保留率为91%。2.纵向评估 PSTD症状和常规CVD危险因素：队列成员在2009年在WTCHP接受了多达15次访视。 评估了哪些心理健康和心血管疾病因素。3.性别和种族/族裔构成多样化： 包括17%的妇女和54%的非西班牙裔白人。具体目标：目标1。第二次亲自执行， 2022- 2023年对WTC心脏队列进行标准化评估，并随访至2026年， 13-14年随访的统计功效，PTSD的高患病率，与全国死亡率的联系 指数.目标2.估计PTSD剂量及其潜在变化对总（致命和非致命）和 非致死性CVD、冠状动脉疾病和脑血管疾病，总体和种族（非西班牙裔白色， 非西班牙裔黑人和西班牙裔）群体。分析将使用2012年至2016年期间对PTSD和CVD的重复评估。 和2026年，并对时间更新的CVD风险因素和COVID-19暴露进行适当调整，使用G- 方法.目标3.评估流行病学的生物学、行为学和创伤史的可信度， 通过测量慢性压力的生物指标，创伤史， 在PTSD剂量的三分位数内随机招募的240名参与者的子样本中， 创新性和意义：如果能够实现以下目标，则拟议的研究具有潜在的重大临床和公共卫生意义： 有助于确定是否：1）CVD发病率和死亡率的风险与PTSD剂量呈负相关; 2）首先 WTCHP中的应答者有权获得CVD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.