Posttraumatic Stress Disorder as a Risk Factor for Cardiovascular Disease: A Literature Review and Proposed Mechanisms
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GAME CHANGERS IN CV RISK RESEARCH (D LEVY, SECTION EDITOR)
Posttraumatic Stress Disorder as a Risk Factor for Cardiovascular Disease: A Literature Review and Proposed Mechanisms Thomas Buckley & Geoffrey Tofler & Holly G. Prigerson
Published online: 6 October 2013 # Springer Science+Business Media New York 2013
Abstract Emotional stress has long been associated with cardiovascular disease (CVD), however it is relatively recent that the evidence for a causal link has been more firmly established. While the term posttraumatic stress disorder (PTSD) has only been described since the 1970s, there is now substantial evidence, among various populations, that PTSD is associated with increased CVD risk, and that this risk is independent of other CVD risk factors. Although it is not possible to identify any one single mechanism responsible for the associations observed, it is likely that increased haemodynamic forces, inflammatory and thrombotic changes as well as elevated cholesterol levels are contributors. Despite the logistic difficulties in researching the physiological responses to PTSD, this should be a priority area for future research to guide therapies targeted at reducing CVD risk associated with this major stress disorder. Keywords Posttraumatic stress . Cardiovascular disease . Risk factor . Mechanism
Introduction Advances over the last two decades in understanding of the mechanism of onset and treatment of acute cardiovascular T. Buckley (*) Department of Cardiology, Faculty of Nursing, The University of Sydney, Royal North Shore Hospital, Sydney, Australia e-mail: [email protected] G. Tofler Department of Cardiology, Sydney Medical School, Royal North Shore Hospital, Sydney, Australia e-mail: [email protected] H. G. Prigerson Center for Psychosocial Epidemiology and Outcomes Research, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA e-mail: [email protected]
disease (CVD), have coincided with increased acceptance of the role of psychological factors, both acute and chronic, in the onset of CVD. While emotional stress has long been associated with CVD, the evidence for a causal link has been more uncertain, especially when compared to traditional risk factors [1]. Because people are under varying emotional stress throughout their lives, it has been more difficult to determine whether an association is coincidental or causal. According to the American Heart Association (AHA), individual response to stress may be a contributing factor for CVD and therefore stress has been classified as a “factor that contributes to heart disease risk through changes to health behaviors and socioeconomic status” [1]. Notwithstanding the contributions of altered health behaviours to CVD risk, other organisations have recognised the unique, or independent contribution of psychological stress in the development of CVD with the National Heart Foundation of Australia recognising psychological stress, such as depression (both episodic and major), as an independent risk f
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