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Association of Posttraumatic Stress Disorder With Stroke in Women Veterans

Ebrahimi R, Dennis P, Shroyer AL, Alvarez C, Beckham J, Sumner J. Association of Posttraumatic Stress Disorder With Stroke in Women Veterans. [Abstract]. Circulation. 2022 Oct 30; 8(146):A12929.


Introduction: Posttraumatic stress disorder (PTSD) has been associated with ischemic heart disease in women veterans. To date, the evidence for the potential association of PTSD with other cardiovascular disorders remains limited. Furthermore, the overwhelming majority of the research in this area has been conducted predominately in men. The goal of this investigation was to evaluate the association of PTSD with incident stroke in a large cohort of women veterans. Methods: Veterans Affairs (VA) electronic health records were used to identify women veterans aged 18 years who visited any VAs nationwide from 1/1/2000-12/31/2017. Diagnosis of each risk factor and disorder was based on administrative billing codes (International Classification of Disease versions 9 and 10). The final study cohorts included 1:2 matched group of patients with and without PTSD respectively. The cohorts were matched for age, traditional risk factors such as diabetes, hypertension, hyperlipidemia and smoking, as well as obesity, chronic kidney disease, psychiatric disorders (depression, anxiety), female specific risk factors (e.g., pre-eclampsia), drug and alcohol dependence, neuroendocrine disorders (e.g., hypo or hyperthyroidism), and number of visits. Cox regression was used to model incident stroke as a function of PTSD. Results: The study population included 398,769 patients, including 132,293 with PTSD and 265,846 matched patients without PTSD. The cox regression analysis revealed that PTSD was significantly associated with greater rates of incident stroke (hazard ratio [HR] = 1.64, 95% confidence interval: 1.43-1.86, p < .001). Conclusion: These results point to a strong association of PTSD with incident stroke in women veterans. Further research is indicated to assess the association of PTSD with a broader range of cardiovascular disorders.

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