Abstract 12702: Association of Posttraumatic Stress Disorder With Incident Ischemic Heart Disease in Women Veterans

Abstract

Introduction: Posttraumatic stress disorder (PTSD) is associated with greater risk of ischemic heart disease (IHD). Women veterans represent a growing, yet understudied, population with high trauma exposure and a unique cardiovascular risk profile, but research on the PTSD-IHD relation in this group is lacking. Hypothesis: PTSD is associated with incident IHD in women veterans. Methods: Veterans Administration (VA) electronic medical records (EMR) was used to identify women veterans who received care from any VA from 1/1/2000-12/31/2017. Exclusion criteria included: no VA follow-up(s) after index visit; IHD diagnosis at or before index visit; IHD diagnosis within 90 days of index visit. Propensity score matching on age at index visit, year of index visit, number of visits before index visit, and presence of traditional and female-specific cardiovascular risk factors and mental and physical health conditions was conducted in a 1:2 ratio to identify 129,510 women veterans with PTSD and 259,020 women veterans without PTSD. PTSD was defined by International Classification of Disease (ICD)-9/ICD-10 diagnosis codes and inpatient or outpatient encounters. Incident IHD was defined as new-onset coronary artery disease, angina, or myocardial infarction diagnoses based on ICD-9/ICD-10 diagnosis codes and inpatient or outpatient encounters. Results: The analytic sample was relatively young (mean age=40.3 ( SD =12.5)). Median length of follow-up was 1,921 days (interquartile range=884-3,547 days). In a propensity score-adjusted Cox proportional hazards model, PTSD was significantly associated with greater risk of developing IHD (HR=1.15, 95% CI 1.10-1.19; P <.001). Secondary stratified analyses indicated that women veterans with PTSD who were of younger age (particularly those aged <40 years), Black race, and Hispanic/Latino ethnicity, plus those exposed to military sexual trauma, exhibited some of the greatest elevations in incident IHD risk. Conclusions: Findings demonstrate that PTSD is an independent predictor of incident IHD in women veterans, especially in younger women and racial and ethnic minorities. Results may have implications for IHD risk assessment in these vulnerable populations.