CHICAGO - A groundbreaking study of 1,946 male veterans of World War II and Korea suggests that vets with symptoms of post-traumatic stress disorder are at greater risk of heart attacks as they age.
The new study is the first to document a link between PTSD symptoms and future heart disease, and joins existing evidence that vets with PTSD also have more autoimmune diseases such as arthritis and psoriasis.
A second study, funded by the Army, found that soldiers returning from combat in Iraq with post-traumatic stress disorder reported worse physical health, more doctor visits and more missed workdays. The Army study is based on a survey of 2,863 soldiers one year after combat.
"The burden of war may be even greater than people think," said the first study's lead author, Laura Kubzansky of the Harvard School of Public Health, who studies anxiety, depression and anger as risk factors for heart disease. Her work, with colleagues from Harvard and Boston University, appears in Monday's Archives of General Psychiatry.
Their study was funded by the National Institutes of Health and the Department of Veterans Affairs. The Army study appears in Monday's American Journal of Psychiatry.
The possible link with heart disease didn't surprise one Iraq veteran diagnosed with PTSD.
"It didn't take a rocket scientist to figure out," said John Oliveira of New Bedford, Mass., a former Navy public affairs officer and veteran of Iraq and Afghanistan. "It should also be a wake-up call that the cost to treat those of us suffering from PTSD could dramatically increase as we age."
Medical authorities first accepted post-traumatic stress disorder as a psychiatric condition in 1980 at the urging of Vietnam veterans.
In PTSD, the body's normal hormonal response to stress becomes trigger-happy, scientists believe. Long after traumatic events, people remain edgy, fearful and prone to nightmares and flashbacks. The continual release of adrenaline prompted by these symptoms may wear down the cardiovascular system, Kubzansky said.
"It's not enough to simply welcome them home and do some immediate evaluation or help with reintegration," she said. "They need to be tracked and watched carefully."
The Harvard and Boston University researchers analyzed data from the Veterans Administration Normative Aging Study, a long-term research project tracking Boston-area vets.
They looked at health records of men who completed either a 46-item questionnaire measuring PTSD symptoms in 1986, or a different 35-item PTSD assessment in 1990. Both questionnaires are recognized tools for diagnosing PTSD and ask about symptoms such as sleep problems, nightmares, numbness, a heightened sense of being on guard and intrusive memories of traumatic events.
Over the 10 to 15 years after completing the questionnaires, the vets with more PTSD symptoms were more likely to have heart attacks. For each level increase in symptoms on the 1990 assessment, the risk of heart attack or chest pain rose 18 percent -- even after the researchers took into account known heart disease risk factors such as smoking, alcohol use and high blood pressure.
Although the men had different levels of PTSD symptoms, very few had enough symptoms for a true diagnosis, Kubzansky said. The study needs to be repeated to see if the findings hold true for PTSD-diagnosed veterans, and for women, she said.
The data also didn't track how frequently the men exercised, so researchers couldn't tell if the men with PTSD symptoms were getting more or less exercise than other veterans.
Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center, called the study "impressive." He said one symptom of PTSD is avoiding activity, which could account for some of the effect on the heart.
Kennedy, who was not involved in the study, said treatment options for PTSD include drugs, talk therapy and behavioral changes such as getting more exercise and taking action to solve small problems in life rather than shutting down emotionally.
"We've got a whole generation of veterans coming back (from Iraq and Afghanistan) and their health needs are just going to be tremendous," Kennedy said.
