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A Prospective Study of PTSD and Early-Age Heart Disease Mortality Among Vietnam Veterans: Implications for Surveillance and Prevention

From the Center for Health Research, Geisinger Clinic, Danville, Pennsylvania, and the Departments of Medicine and Pediatrics, Mount Sinai School of Medicine, New York, New York.

Address correspondence and reprint requests to Joseph A. Boscarino, Center for Health Research, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA 17822. E-mail: jaboscarino{at}geisinger.edu

Objective: To examine prospectively early-age heart disease (HD) among a national random sample of 4328 male Vietnam veterans, who did not have HD at baseline in 1985. Studies have suggested that posttraumatic stress disorder (PTSD) may result in cardiovascular disease. However, many past studies had important methodological limitations to their designs.

Method: Using Cox regressions, we assessed PTSD, age, race, intelligence, family history, obesity, smoking, alcohol abuse, antisocial personality, and depression in predicting HD mortality at follow-up in December 31, 2000. The men were <65 years old at follow-up.

Results: Using two PTSD measures, a Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III) measure (D-PTSD) and one developed by Keane (K-PTSD), we found that among Vietnam theater and era veterans combined (era veterans had no Vietnam service), having PTSD was associated with HD mortality for D-PTSD (hazard ratio (HR) = 2.25, p = .045) and approached significance for K-PTSD (HR = 2.16, p = .066). However, having higher PTSD symptoms on either scale was associated with mortality, with a 5-point increase associated with 20% increase in mortality risk (all p < .05). Controlling for lifetime depression only slightly altered the results. The effects for theater veterans alone were stronger (D-PTSD: HR = 2.58, p = .025; K-PTSD: HR = 2.73, p = .022). Among theater veterans, controlling for lifetime depression or combat exposure made little difference.

Conclusion: PTSD was prospectively associated with HD mortality among veterans free of HD at baseline. This study suggests that early-age HD may be an outcome after military service among PTSD-positive veterans.

Key Words: posttraumatic stress disorder • cardiovascular disease • survival analysis • depression • veterans

Abbreviations: TV = theater veteran; EV = era veteran; POW = prisoner of war; PTSD = posttraumatic stress disorder; DIS = Diagnostic Interview Schedule; DSM-III = Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition; HD = heart disease; ECG = electrocardiogram; BP = blood pressure; HPA = hypothalamic-pituitary-adrenocortical; SAM = sympathetic-adrenal-medullary; NDI = National Death Index; HR = hazard ratio; CI = Confidence Interval.

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