PTSD May Hike Risk of Heart Attack, Stroke

Post-traumatic stress disorder (PTSD) may reduce the ability of blood vessels to fully dilate, which may raise the risk of heart attack and stroke, according to a new study of veterans published in the Journal of the American Heart Association.

The findings showed that the blood vessels of veterans with PTSD were less reactive and did not expand normally in response to stimuli compared to veterans without PTSD. Less reactive blood vessels are associated with the development of heart disease and other serious conditions.

“Traditional risk factors such as high blood pressure, diabetes, high cholesterol and smoking, have not fully explained why people with PTSD seem to be at higher heart disease risk. Our study suggests that chronic stress may directly impact the health of the blood vessels,” said lead author Marlene Grenon, M.D., associate professor of surgery at the University of California San Francisco and vascular surgeon at the Veterans Affairs Medical Center San Francisco /Veterans Affairs Medical Center-Surgical Services.

For the study, the researchers used a standard test known as flow-mediated dilation (FMD) to gauge how well an artery in the arm relaxes and expands in response to the squeezing of a blood-pressure cuff.

They compared the FMD scores of 67 veterans (average age 68, 99 percent male) with PTSD and 147 veterans (average age 69, 91 percent male) without PTSD. The presence of PTSD was defined as a score of 40 or higher on the PTSD Symptom Checklist.

The findings showed that veterans with PTSD had significantly lower FMD scores; that is, their blood vessels expanded only 5.8 percent compared to 7.5 percent among non-PTSD veterans, indicating a less-healthy response in the lining of their blood vessels.

Veterans with PTSD were more likely to be male and to have a diagnosis of depression, but less likely to be taking ace-inhibitors or beta-blockers to treat high blood pressure. Aside from PTSD, lower scores on the FMD test were also linked to increasing age, worse renal function, and high blood pressure.

After adjusting for differences in age and the presence of other conditions and treatments, PTSD itself was still very strongly linked to reduced blood vessel dilation.

While the current study only included veterans, PTSD can also occur in non-veterans as a result of experiencing or observing a terrifying event, such as warfare, natural disasters, sexual assault, other physical violence, or trauma.

People with PTSD may experience prolonged anxiety, flashbacks, nightmares and many other severe symptoms. The disorder is estimated to affect 7.7 million people in the United States according to the U.S. Department of Health and Human Services National Institutes of Health.

Source: American Heart Association

 
Heart and cardiovascular system photo by shutterstock.

Vets Receive Care for Sub-Clinical PTSD

A new study reports that veterans who fall just below the threshold for a diagnosis of post-traumatic stress disorder (PTSD) respond to a psychotherapy regimen better than those with full PTSD.

Investigators believe the study highlights the need to recognize veterans suffering from an overlooked condition called subclinical PTSD.

Researchers from the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina (MUSC) discuss their findings in the Journal of Anxiety Disorders.

“The study shows not only that we can treat those experiencing subclinical presentations of PTSD, but also that those with subclinical PTSD may actually respond better to treatment than those with more severe forms of the disease,” says MUSC investigator Kristina Korte, Ph.D.

Researchers explain that just like patients with full PTSD, those with subclinical PTSD have experienced a traumatic event and are regularly re-experiencing it, often in nightmares or flashbacks.

Patients with full PTSD also experience hyperarousal (i.e., they are easily startled) and avoid reminders of the event, for example by withdrawing from social interaction or turning to substance abuse.

In addition re-experiencing the event, patients with subclinical PTSD may exhibit either hyperarousal or avoidance, but not both.

Psychologists began noticing this pattern more frequently in the nineties in veterans returning from the first Iraq War, and even more frequently in veterans returning from Iraq and Afghanistan in the last decade.

As researchers have learned more about these patients over time, varying and sometimes conflicting symptoms have provided an incomplete picture of the disorder and how to treat it.

The issue is complicated as those with subclinical PTSD are often excluded from clinical trials testing treatments for PTSD. That is, patients with only some symptoms of PTSD commonly aren’t included in the healthy control group or in the group with full PTSD.

As a result, there is still no standard psychotherapy for treating subclinical PTSD as there is for full PTSD.

According, the researchers devised an intuitive approach — Why not treat subclinical PTSD patients with one of the standard evidence-based psychotherapy tools already being used in PTSD patients?

To do this, they enrolled 200 patients with combat-related PTSD symptoms, identifying those with either subclinical or full PTSD.

For eight weeks, patients received intensive weekly sessions of behavioral activation and therapeutic exposure therapy, designed to lessen their PTSD symptoms by helping them safely re-experience and resolve elements of the original trauma.

Psychologists rated the patients’ PTSD symptoms and had patients rate their own symptoms before, during, and after the eight weeks.

The results were encouraging. Those with subclinical or full PTSD each experienced a real drop in PTSD symptoms after treatment. The striking result was in how much those symptoms dropped: 29 percent in those with subclinical PTSD as compared to 14 percent with full PTSD.

It may seem obvious that patients with a less severe form of PTSD would respond better to standard psychotherapy, but the implications for treatment are far-reaching.

That is, PTSD symptoms often worsen over time; as they do, treatments become less effective at reducing symptoms. In this context, subclinical PTSD could be seen as “early-stage” PTSD, in that treatment might be more effective when the disorder is caught early.

Researchers hope these early studies can move beyond men in combat to civilians of both sexes.

“It is our hope that providing treatment for subclinical PTSD could have a significant impact on the cost-effectiveness of treating this common disorder,” says Korte.

“It could lead to the prevention of more intractable forms of PTSD that can occur when subclinical PTSD goes untreated.”

Source: Medical University of South Carolina/EurekAlert

 
Veteran in counseling photo by shutterstock.