创伤后应激障碍严重程度和心血管疾病结局大幅降低

IF 3.7 2区 医学 Q1 PSYCHIATRY
Joanne Salas , Poorva Sheth , Beth E. Cohen , Kenneth E. Freedland , Allan S. Jaffe , Paula P. Schnurr , Matthew Friedman , Patrick J. Lustman , Jeffrey F. Scherrer
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引用次数: 0

摘要

背景:创伤后应激障碍(PTSD)与心血管疾病(CVD)的风险相关。身体健康的改善通常伴随着PTSD严重程度的大幅降低,但尚不清楚合并PTSD和CVD的患者在PTSD改善后是否会出现更好的CVD结果。方法使用2011年至2022年的未识别医疗记录数据创建7120名退伍军人健康管理局患有PTSD和共病CVD的患者队列。以PTSD检查表(PCL)降低≥20分为标准,暴露对PTSD有临床意义的改善。熵平衡控制混杂。Cox比例风险模型估计了临床上有意义的PCL降低与CVD结果(心肌梗死或血运重建手术、全因死亡率和卒中)之间的关系。结果年龄在65 ~ 80岁之间的患者占52.2%,其中95.5%为男性,17.3%为黑人,79.2%为白人。20.4%的患者出现有临床意义的PTSD改善。在控制混杂因素后,PTSD有临床意义改善与无临床意义改善的患者在心肌梗死或血运重建术的风险上没有显著差异(HR = 1.07;95% CI: 0.94-1.20),全因死亡率(HR = 1.02;95% CI: 0.89-1.17),卒中(HR = 1.10;95%置信区间:0.96—-1.26)。种族、年龄和抑郁均未显著改变PTSD改善与不良心血管疾病结局风险的关联。结论:在退伍军人样本中,创伤后应激障碍严重程度的大幅降低与CVD结果的改善或恶化无关。需要进行研究以确定是否在其他患有PTSD和CVD合并症的患者中发现有临床意义的PTSD改善和与CVD结果缺乏关联。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Large decrease in posttraumatic stress disorder severity and cardiovascular disease outcomes

Background

Posttraumatic stress disorder (PTSD) is associated with risk for cardiovascular disease (CVD). Improved physical health often follows large decreases in PTSD severity, but it is not known if better CVD outcomes follow PTSD improvement in patients with comorbid PTSD and CVD.

Methods

De-identified medical record data between 2011 and 2022 was used to create a cohort of 7120 Veterans Health Administration patients with PTSD and comorbid CVD. The exposure was clinically meaningful PTSD improvement defined as ≥20-point PTSD Checklist (PCL) decrease. Entropy balance controlled for confounding. Cox proportional hazard models estimated the association between clinically meaningful PCL decrease and CVD outcomes: myocardial infarction or revascularization procedure, all-cause mortality, and stroke.

Results

About half (52.2 %) of the sample was 65–80 years of age, 95.5 % were male, 17.3 % identified as Black and 79.2 % as White race. Clinically meaningful PTSD improvement occurred for 20.4 % of patients. After controlling for confounding, those with vs. without clinically meaningful PTSD improvement did not significantly differ on risk for myocardial infarction or revascularization procedure (HR = 1.07; 95 %CI:0.94–1.20), all-cause mortality (HR = 1.02; 95 %CI:0.89–1.17), and stroke (HR = 1.10; 95 %CI:0.96–1.26). Neither race, age nor depression significantly modified the association of PTSD improvement and risk for adverse CVD outcomes.

Conclusions

In this sample of veterans, large reductions in PTSD severity were not associated with better or worse CVD outcomes. Research is needed to determine if clinically meaningful PTSD improvement and the lack of association with CVD outcomes is seen in other populations of patients with comorbid PTSD and CVD.
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来源期刊
General hospital psychiatry
General hospital psychiatry 医学-精神病学
CiteScore
9.60
自引率
2.90%
发文量
125
审稿时长
20 days
期刊介绍: General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.
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