PTSD and Increased Incidence of Cardiovascular Disease: Independent Effects and Moderation of Risk by Comorbidities, Sex, and Age

Biopsychosoc Sci Med. 2025 Sep 30. doi: 10.1097/PSY.0000000000001442. Online ahead of print.

ABSTRACT

OBJECTIVE: Posttraumatic stress disorder (PTSD) is associated with increased risk of cardiovascular disease (CVD) and multiple comorbidities. We evaluated whether comorbidities, sex, or age modify PTSD-related risk of hypertension or atherosclerotic CVD (ASCVD).

METHODS: Associations of PTSD, comorbidities (metabolic and behavioral risk factors, depression, and sleep disorders), sex, and age (<40 vs. ≥40 y) with incident hypertension and ASCVD were assessed in a large sample of U.S. Army soldiers (86.2% male; 93.7% <age 40). Discrete-time survival analyses of medical record ICD codes compared all person-months with initial hypertension diagnosis (n=49,656 cases) to an equal-probability sample of control person-months. Parallel analyses were conducted for ASCVD (CAD, MI, stroke, heart failure; n=2,427 person-months).

RESULTS: In univariate models, PTSD predicted subsequent hypertension (OR=3.0 [95% CI=2.9-3.1]), and ASCVD (OR=2.7 [95% CI=2.2-3.3]). Associations remained significant adjusting for comorbidities and sociodemographic/service-related variables (Hypertension: OR=1.9 [95% CI=1.8-2.0]; ASCVD: OR=1.4 [95% CI=1.2-1.8]). Sex, age, and each comorbidity independently predicted hypertension, and PTSD interacted with sex, age, metabolic risk factors, depression, and sleep disorders. Stratification indicated stronger PTSD-hypertension associations among men, and among those: <age 40, without metabolic risk factors, without depression, and without sleep disorders. Standardized risk estimates for hypertension were higher among those with versus without PTSD, with versus without each comorbidity, among men, and among those ≥age 40. Comorbidities and age independently predicted ASCVD, but did not modify PTSD-ASCVD associations.

CONCLUSIONS: PTSD and comorbidities independently predict hypertension and ASCVD, and sex, age, and comorbidities modify PTSD-hypertension relationships, thus suggesting that preventive interventions address both PTSD and comorbidities.

PMID:41032051 | DOI:10.1097/PSY.0000000000001442