创伤后应激障碍与老年退伍军人中心血管疾病发病风险的关系。
PTSD and Risk of Incident Cardiovascular Disease in Aging Veterans.
机构信息
Department of Psychiatry, University of California, San Francisco, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA; California School of Professional Psychology at Alliant International University, San Francisco, CA.
Department of Psychiatry, University of California, San Francisco, San Francisco, CA; Department of Neurology and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
出版信息
Am J Geriatr Psychiatry. 2016 Mar;24(3):192-200. doi: 10.1016/j.jagp.2014.12.003. Epub 2014 Dec 9.
OBJECTIVES
To determine if late-life posttraumatic stress disorder (PTSD) is associated with cardiovascular disease in a sample of older veterans, and whether the association is independent of medical and psychiatric comorbities.
DESIGN
Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (2000-2011).
SETTING
VA medical centers in the United States.
PARTICIPANTS
A total of 138,341 veterans 55 years and older without cardiovascular disease at study baseline (2000-2003).
MEASUREMENTS
PTSD and cardiovascular disease (as defined by diagnoses of: cerebrovascular disease [CVD], congestive heart failure [CHF], myocardial infarction [MI], and peripheral vascular disease [PVD]) were identified by ICD-9 codes during study baseline (2000-2003) and follow-up (2004-2011), respectively.
RESULTS
3% of veterans (N = 4,041) had a baseline diagnosis of PTSD. Unadjusted increased risk of incidence of CVD was 80%, CHF was 56%, MI was 82%, and PVD was 60% in veterans with PTSD compared with those without PTSD. After adjustment for demographics, medical comorbidities, substance use, and psychiatric comorbidities, veterans with late-life PTSD were at a 45% increased risk for incident CVD, 26% increased risk for incident CHF, 49% increased risk for incident MI, and 35% increased risk for PVD compared with veterans without late-life PTSD.
CONCLUSIONS
Findings highlight the longitudinal impact of PTSD on increasing the incidence of cardiovascular disease in older adults. This study implies the need for greater monitoring and treatment of PTSD in older persons, particularly older veterans, to assist in preventing adverse outcomes, such as cardiovascular disease, over the long term.
目的
在老年退伍军人样本中，确定晚年创伤后应激障碍（PTSD）是否与心血管疾病相关，以及该关联是否独立于医疗和精神共病。
设计
使用美国退伍军人事务部（VA）国家患者护理数据库（2000-2011 年）进行的回顾性队列研究。
地点
美国 VA 医疗中心。
参与者
共有 138341 名年龄在 55 岁及以上、基线时无心血管疾病（2000-2003 年）的退伍军人。
测量
通过 ICD-9 代码在基线研究期间（2000-2003 年）和随访期间（2004-2011 年）分别确定 PTSD 和心血管疾病（定义为脑血管疾病[CVD]、充血性心力衰竭[CHF]、心肌梗死[MI]和外周血管疾病[PVD]的诊断）。
结果
3%的退伍军人（N=4041）在基线时被诊断患有 PTSD。与无 PTSD 的退伍军人相比，患有 PTSD 的退伍军人发生 CVD 的风险增加了 80%，CHF 为 56%，MI 为 82%，PVD 为 60%。在调整人口统计学、医疗合并症、物质使用和精神共病后，与无晚年 PTSD 的退伍军人相比，患有晚年 PTSD 的退伍军人发生 CVD 的风险增加了 45%，发生 CHF 的风险增加了 26%，发生 MI 的风险增加了 49%，发生 PVD 的风险增加了 35%。
结论
研究结果强调了 PTSD 对老年人心血管疾病发病率的长期影响。本研究表明，需要对老年人，特别是老年退伍军人的 PTSD 进行更多的监测和治疗，以帮助预防长期的不良后果，如心血管疾病。
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