After trauma, women face heart disease risk

Women who experience a traumatic event and develop post-traumatic stress disorder (PTSD) may be
at increased risk for heart disease, a new large study suggests.
In the study, researchers found that women who had four or more symptoms of PTSD after a
traumatic event had a 60 percent increased risk of cardiovascular disease, such as a heart attack or
stroke, than women who experienced no trauma, over a 20-year period.
Women who had experienced traumatic events but who didn't report experiencing symptoms of
PTSD had a 45 percent increased risk of cardiovascular disease, the study found.
"PTSD has often been conceptualized or thought of as just a psychological disorder," said Jennifer
Sumner, the study's lead author and an epidemiology fellow at Columbia University's Mailman
School of Public Health.
"What our findings suggest is that PTSD has effects that go beyond mental health, that also impact
physical heath," Sumner told Live Science. [Top 10 Mysteries of the Mind]

PTSD, which affects nearly 8 million Americans yearly, is twice as common in women as it is in men,
according to the National Center for PTSD. Symptoms include flashbacks of the trauma, insomnia
and emotional numbness.
In the new study, published today (June 29) in the journal Circulation, the researchers collected data
from nearly 50,000 women who were enrolled in a long-running study called the Nurses' Health
Study II. Every two years for two decades, the participants indicated if they had experienced a heart
attack or stroke (and the researchers confirmed these events by reviewing medical records). In the
final year of the study, participants were also asked to complete a questionnaire that asked whether
they had experienced trauma and PTSD symptoms.

The researchers also determined to what extent the women's health behaviors (such as smoking and
lack of activity) and other medical conditions (such as high blood pressure) accounted for the link
seen in the study between experiencing trauma and later having heart disease. In women who had
experienced trauma and exhibited four or more symptoms of PTSD, the other factors accounted for
about half of the association, the researchers found. This suggests that the link between PTSD and
heart disease is not just physiological, but that health behaviors also play a substantial role, the
researchers said.
"To our knowledge, this is the first study in women to examine health behaviors and medical risk
factors as potential mediators of the associations between trauma exposure, PTSD symptoms and
CVD incidence," the researchers wrote.
Still, physiological factors also play a role in the association between PTSD and CVD. For example,
research has shown that PTSD is associated with increased levels of inflammation in the body as
well as elevations in blood pressure and heart rate,all of which are contributors to cardiovascular
disease, said Donald Edmondson, an assistant professor of behavioral medicine at Columbia
University, who was not involved with the new study.
It's unclear whether treating women's PTSD could improve their heart health, he said. "The question
is, if we were to treat PTSD, will it improve the things that we know go along with PTSD?"
Edmondson told Live Science.
The researchers intend to explore how intervention can offset the risk in future studies, Sumner
said.
"It will be important to examine whether successful PTSD treatment has a positive impact on
cardiovascular health," the researchers wrote.
The new findings suggest "the importance for looking at physical health in women with PTSD and
having integrated physical as well as mental health care," Sumner said.
"Right now, the American Heart Association doesn't acknowledge stress or PTSD as an established
risk factor for heart disease," said Sumner. "These findings, along with other work in the literature,
suggest that it's an important factor to take into consideration," she said.
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