In a study of 1,022 men and women with heart disease, those with post-traumatic stress disorder perceived the effects of their disease as more burdensome and disabling than did those without PTSD, even when their actual heart health was no worse by objective measures.
The results are reported by researchers at the San Francisco VA Medical Center and the University of California, San Francisco in the November 2009 issue of the Archives of General Psychiatry.
The researchers, led by Beth E. Cohen, MD, MAS, a staff physician at SFVAMC, looked at an array of perceived effects of heart disease as reported by the study participants, including chest pain frequency and severity, limitations on physical activity and daily functioning, and overall quality of life.
They then measured the participants’ actual cardiac function according to a variety of objective measures: treadmill exercise capacity; left ventricular ejection fraction, which measures how efficiently the heart pumps blood; and inducible ischemia, which measures how much oxygen the heart receives during exercise.
The 95 patients with PTSD reported significantly greater perceived symptom burden, greater physical limitation, and reduced quality of life than those without PTSD, even when their objective measures of cardiac function were equivalent.
The differences in perception remained even after the researchers excluded participants with depression, “which could also be expected to affect how people perceive the severity of their heart disease,” according to Cohen, who is also an assistant professor of medicine at UCSF.
“There is something unique and independent about PTSD that makes heart disease more burdensome, irrespective of actual heart function,” concludes Cohen. “Unfortunately, we can’t venture to speculate what that is without more detailed data.”
The study authors cite a body of research that suggests a PTSD rate of 8 to 12 percent in the general population and 13 to 30 percent among military veterans.
Cohen suggests that for patients with both heart disease and PTSD, “we need to look at not only improving physical measures like cholesterol and blood pressure, but treating the symptoms of PTSD as well. In addition to improving patients’ emotional health, our findings suggest that it may also improve their level of function and quality of life. And that’s what we’d really like to know – how treating PTSD can affect heart health.”
Currently, Cohen’s research team is working on a follow-up study that looks at the same participants five years later. “This will allow us to evaluate if the people with PTSD did worse over time in terms of actual heart outcomes,” she says.
Co-authors of the study were Charles R. Marmar, MD, and Thomas Neylan, MD, of SFVAMC and UCSF, and Nelson B. Schiller, MD, and Sadia Ali, MD, MPH, of UCSF. The senior author was Mary Whooley, MD, of SFVAMC and UCSF.
The research was supported by funds from the National Institutes of Health, the Department of Veterans Affairs, the National Heart, Lung, and Blood Institute, the American Federation for Aging Research, the Robert Wood Johnson Foundation, the Ischemia Research and Education Foundation, and the Nancy Kirwan Heart Research Fund. Some of the funds were administered by the Northern California Institute for Research and Education.
NCIRE - The Veterans Health Research Institute is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
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