Stress-Related Disorders Associated with Multiple CVD Risk

A new study reveals that stress-related disorders may increase the risk for cardiovascular disease (CVD), especially during the first year after diagnosis.

Researchers at the University of Iceland (HI; Reykjavík), Karolinska Institutet (KI; Solna, Sweden), and other institutions conducted a population based, sibling controlled cohort study in order to assess the association between stress-related disorders and subsequent CVD risk. The study participants included 136,637 patients in the Swedish National Patient Register with stress related disorders, including post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions; 171,314 unaffected full siblings of these patients; and 1,366,370 matched unexposed people from the general population.

The main outcome measures included primary diagnosis of incident CVD, including specific subtypes such as ischemic heart disease, cerebrovascular disease, emboli/thrombosis, hypertensive diseases, heart failure, arrhythmia/conduction disorder, and fatal CVD, as well as 16 individual diagnoses of CVD. The results revealed that among the exposed patients, their unaffected full siblings, and the matched unexposed participants, the crude incidence rate of any CVD was 10.5, 8.4, and 6.9 per 1,000 person-years, respectively, during 27 years of follow-up.

Compared with their unaffected siblings, exposed patients had almost twice the risk for any CVD during the first year of follow-up. The association was independent of sex, familial characteristics, history of somatic or psychiatric disorders, and psychiatric comorbidities. Associations were stronger among those who were younger at index date, and also between stress-related disorders and early-onset CVD. The presence of psychiatric comorbidity did not alter these associations, with the exception of fatal CVD. The results were similar when compared with the population-matched cohort. The study was published on April 10, 2019, in BMJ.

“The often catastrophic nature of cardiovascular disease events emphasizes the importance of being alert for CVD in patients with stress-related disorders, particularly during the months after diagnosis,” concluded lead author Huan Song, MD, PhD, of HI and KI, and colleagues. “These findings call for enhanced clinical awareness and, if verified, monitoring or early intervention among patients with recently diagnosed stress related disorders.”

PTSD is the most severe and widely studied form of stress related disorder, characterized by re-experiencing, avoidance, negative cognitions and mood, and hyperarousal following the traumatic event.

Related Links:
University of Iceland
Karolinska Institutet