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Invited Commentary
March 17, 2021

Exploring Posttraumatic Stress Disorder as a Cardiovascular Risk Factor in Women Veterans: The Heart of the Matter

Author Affiliations
  • 1Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
  • 2Department of Medicine, University of California, San Francisco
JAMA Cardiol. Published online March 17, 2021. doi:10.1001/jamacardio.2021.0236

The connection between emotional and physical health has long been recognized, with a great deal of research focusing on the risk of cardiovascular disease (CVD). The landmark INTERHEART study1 of nearly 30 000 people from 52 countries found that psychosocial factors, including depression and stressful life events, accounted for approximately one-third of the population-attributable risk of myocardial infarction. Subsequent studies have attempted to isolate the risk associated with psychological trauma and posttraumatic stress disorder (PTSD). Two meta-analyses2,3 have linked PTSD to increased CVD risk, with the most recent2 finding an adjusted hazard ratio (HR) of 1.46 (95% CI, 1.46-1.77). Understandably, there has been great interest in examining the association between PTSD and CVD in veterans, given their high rates of exposure to trauma and development of PTSD. Indeed, much of the early work in this area was conducted exclusively in male veterans. Although 2 large epidemiological studies4,5 have confirmed the association of posttraumatic stress and CVD in community samples of women, there remains a lack of information in women veterans.