Post-Traumatic Stress Disorder and Cardiovascular Diseases : A Cohort Study of Men and Women Involved in Cleaning the Debris of the World Trade Center Complex

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d8847703e167">Background</h5> <p id="P1">To determine whether post-traumatic stress disorders (PTSD) is a risk factor for myocardial infarction (MI) and stroke, beyond the expected effects from recognized cardiovascular risk factors and depression. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d8847703e172">Methods and Results</h5> <p id="P2">World Trade Center (WTC)-Heart is an observational prospective cohort study of 6481 blue-collar first responders nested within the WTC Health Program in New York City. Baseline measures in 2012 and 2013 included: blood pressure, weight and height, and blood lipids. PTSD, depression, smoking, and dust exposure during the 2001 cleanup were self-reported. During the 4-year follow-up, outcomes were assessed through: 1. Interview-based incident, non-fatal MI and stroke, validated in medical charts (n=118). 2. Hospitalizations for MI and stroke for New York City and State residents (n=180)). Prevalence of PTSD was 19.9% in men and 25.9% in women, that is, at least twice that of the general population. Cumulative incidence of MI or stroke was consistently larger for men or women with PTSD across follow-up. Adjusted hazard ratios (aHR) were: 2.22 (95% CI: 1.30–3.82) for MI, 2.51 (1.39–4.57) for stroke. For pooled MI and stroke, aHRs were 2.35 (1.57–3.52) in all, and 1.88 (1.01–3.49) in men free of depression. Using hospitalization registry data, aHR were 2.17 (1.41–3.32) for MI, 3.01 (1.84–4.93) for stroke, and, for pooled MI and stroke, 2.40 (1.73–3.34) in all, HR=2.44 (1.05–5.55) in women, and aHR=2.27 (1.41–3.67) in men free of depression. WTC dust exposure had no effect. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d8847703e177">Conclusions</h5> <p id="P3">This cohort study confirms that PTSD is a risk factor for MI and stroke of similar magnitude in men and women, independently of depression. </p> </div>