Biggest risk seen soon after diagnosis
Clinically-confirmed stress conditions, such as post-traumatic stress disorder (PTSD) or acute stress reaction, may be linked to an increased cardiovascular disease risk, a sibling-controlled study in Sweden showed.
Cardiovascular disease was most common among such patients, at 10.5 per 1,000 person-years compared with 8.4 and 6.9 per 1,000 person-years for unaffected full siblings and for the matched unexposed individuals, respectively, over up to 27 years of follow-up.
Notably, the highest hazard ratios were 3.37 for cardiac arrest, 5.64 for cerebrovascular disease other than stroke or arachnoidal bleeding, 5.00 for conduction disorders, and 6.95 for heart failure, all of which were significant within the first year of a stress related disorder diagnosis, the investigators found.
Beyond one year, the risks were still significant but attenuated, ranging from a HR of 1.12 for arrhythmia to 2.02 for artery thrombosis or embolus, reported Huan Song, MD, PhD, of the University of Iceland, and colleagues in The BMJ.
"These findings call for enhanced clinical awareness and, if verified, monitoring or early intervention among patients with recently diagnosed stress related disorders," the investigators wrote.
The study defined clinically-confirmed stress-related disorders as those following a significant life stress or a trauma and resulting in a first outpatient or inpatient visit with the main diagnosis coded as PTSD, acute stress reaction, or adjustment disorder and other stress reactions.
The growing evidence base demonstrates that effect of severe stress reactions as it relates to cardiovascular disease, but much of the literature focused on male cohorts of active duty military or veterans as it relates to post-traumatic stress disorder (PTSD) or self-reported PTSD symptoms, the researchers noted.
The connection between mood disorders like depression and a higher risk of cardiovascular disease are "well established," and a robust, albeit slightly contentious, literature connects cardiovascular disease with anxiety disorders. However, information is limited on the link between cardiovascular disease and other psychiatric disorders, noted Simon Bacon, MSc, PhD, of Concordia University in Montreal, in an accompanying editorial.
Looking ahead, "well designed studies evaluating more appropriate interventions will be critical not only to confirm the inferences of the new study but also to provide real benefits to patients," Bacon wrote.
Song's population-based study assessed an estimated 130,000 people with stress-related disorders, 170,000 of their unaffected full siblings, and 1.4 million matched unexposed individuals in the general population. The median follow-up time was 6.2 to 6.9 years for these groups.
The cohort's median age was 36 years as of the index date. While there was an equal sex distribution among the unaffected siblings, 63% of exposed participants with stress-related conditions were women.
Using the Swedish Multi-Generation Register and the Swedish National Patient Register, which have nearly complete data on family links and all medical diagnoses, the researchers did a matched cohort study and a sibling analysis controlling for psychiatric comorbidities, history of somatic and psychiatric conditions, and familial confounders.
Exclusion criteria included a history of any cardiovascular disease prior to the diagnosis of a stress-related condition, birth prior to 1932, and receiving a diagnosis prior to the age of 5 years.
The investigators acknowledged several limitations of the study: late inclusion of outpatient specialist care documents in the National Patient Register, lack of data from primary care, and a span of over a 27 year period during which the criteria for a stress-related disorder diagnosis might have changed. Other limitations included that traumatic life experiences could affect both sibling groups and that there was no information on behavior-related factors.
The study was supported by a Grant of Excellence, the Icelandic Research Fund, an ERC Consolidator Grant, the Karolinska Institutet, and the Swedish Research Council through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences.
Song reported no relevant disclosures.
Bacon disclosed relationships with GSK, Abbvie, Schering-Plough, Merck, AstraZeneca, Janssen, Sigesa, Novartis, and Bayer.
Source Reference: Song H, et al "Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study" BMJ 2019; DOI: 10.1136/bmj.l1255.
Source Reference: Bacon SL, "Stress, psychiatric disorders, and cardiovascular disease" BMJ 2019; DOI: 10.1136/bmj.l1577.
Read the original article on Medpage Today: Stress Disorders Linked to CV Disease