Leo Sher, M.D.

Multiple lines of evidence suggest that psychological problems are associated with cardiovascular disorders (1,2). Studies of war veterans from prior wars have shown that those with posttraumatic stress disorder (PTSD) are at substantially increased risk of developing and dying from cardiovascular disease (3,4). A research group from San Francisco examined the association of PTSD and other mental disorders with cardiovascular risk factors using national data from veterans of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Their report has just been published in the Journal of the American Medical Association (5).The study population consisted of about 300,000 war veterans who were new users of the VA health care system from October 7, 2001 (the start of OEF) to September 30, 2008. Researchers found that the most common psychiatric diagnosis was PTSD (24% prevalence). PTSD was frequently comorbid with other psychiatric disorders. For example, 53% of individuals with PTSD had comorbid depression. Veterans with psychiatric diagnoses had a significantly higher prevalence of all cardiovascular risk factors (tobacco use, hypertension, dyslipidemia, obesity and diabetes). The authors of the study reported that after adjustment for several potential confounding factors, male and female OEF/OIF veterans with psychiatric diagnoses had significantly greater rates of tobacco use, hypertension, hyperlipidemia, and obesity than those without mental health diagnoses. The results of this study underline the importance of recognition and treatment of mental health problems in war veterans.

References

1. Sher L. (editor). Psychological Factors and Cardiovascular Disorders: The Role of Psychiatric Pathology and Maladaptive Personality Features. Hauppauge, New York: Nova Science Publishers, 2008. 365 pp.

2. Sher L. (editor). Psychological Factors and Cardiovascular Disorders: The Role of Stress and Psychosocial Influences. Hauppauge, New York: Nova Science Publishers, 2009. 468 pp.

3. Kang HK, Bullman TA, Taylor JW. Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war. Ann Epidemiol. 2006;16(5):381-386.

4. Kubzansky LD, Koenen KC, Spiro A III, Vokonas PS, Sparrow D. Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Arch Gen Psychiatry. 2007;64(1):109-116.

5. Cohen BE, Marmar C, Ren L, Bertenthal D, Seal KH. Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan war veterans using VA health care. JAMA 2009;302(5):489-92.