Large decrease in posttraumatic stress disorder severity and cardiovascular disease outcomes

Abstract

Background: Posttraumatic stress disorder (PTSD) is associated with risk for cardiovascular disease (CVD). Improved physical health often follows large decreases in PTSD severity, but it is not known if better CVD outcomes follow PTSD improvement in patients with comorbid PTSD and CVD.

Methods: De-identified medical record data between 2011 and 2022 was used to create a cohort of 7120 Veterans Health Administration patients with PTSD and comorbid CVD. The exposure was clinically meaningful PTSD improvement defined as ≥20-point PTSD Checklist (PCL) decrease. Entropy balance controlled for confounding. Cox proportional hazard models estimated the association between clinically meaningful PCL decrease and CVD outcomes: myocardial infarction or revascularization procedure, all-cause mortality, and stroke.

Results: About half (52.2 %) of the sample was 65-80 years of age, 95.5 % were male, 17.3 % identified as Black and 79.2 % as White race. Clinically meaningful PTSD improvement occurred for 20.4 % of patients. After controlling for confounding, those with vs. without clinically meaningful PTSD improvement did not significantly differ on risk for myocardial infarction or revascularization procedure (HR = 1.07; 95 %CI:0.94-1.20), all-cause mortality (HR = 1.02; 95 %CI:0.89-1.17), and stroke (HR = 1.10; 95 %CI:0.96-1.26). Neither race, age nor depression significantly modified the association of PTSD improvement and risk for adverse CVD outcomes.

Conclusions: In this sample of veterans, large reductions in PTSD severity were not associated with better or worse CVD outcomes. Research is needed to determine if clinically meaningful PTSD improvement and the lack of association with CVD outcomes is seen in other populations of patients with comorbid PTSD and CVD.

Keywords: Cardiovascular disease; Epidemiology; Psychiatry; Veterans.