Posttraumatic Stress Disorder and Risk for Stroke in Young and Middle-Aged Adults: A 13-Year Cohort Study.

Autor: Rosman L; From the Department of Medicine, Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill (L.R.).; Department of Internal Medicine, Division of Cardiovascular Medicine (L.R., R.L., A.E.G., P.W.C., C.E.C., M.M.B.), Yale School of Medicine, New Haven, CT., Sico JJ; Department of Internal Medicine, Division of General Medicine (J.J.S., S.H.), Yale School of Medicine, New Haven, CT.; Department of Neurology and Center for Neuroepidemiological and Clinical Neurological Research (J.J.S.), Yale School of Medicine, New Haven, CT.; VA Connecticut Healthcare System, West Haven (J.J.S., A.E.G., P.W.C., C.E.C., C.B., S.H.)., Lampert R; Department of Internal Medicine, Division of Cardiovascular Medicine (L.R., R.L., A.E.G., P.W.C., C.E.C., M.M.B.), Yale School of Medicine, New Haven, CT., Gaffey AE; Department of Internal Medicine, Division of Cardiovascular Medicine (L.R., R.L., A.E.G., P.W.C., C.E.C., M.M.B.), Yale School of Medicine, New Haven, CT.; VA Connecticut Healthcare System, West Haven (J.J.S., A.E.G., P.W.C., C.E.C., C.B., S.H.)., Ramsey CM; Yale Center for Medical Informatics (C.M.R., C.B.), Yale School of Medicine, New Haven, CT.; Department of Emergency Medicine (C.M.R., J.D., C.B.), Yale School of Medicine, New Haven, CT., Dziura J; Department of Emergency Medicine (C.M.R., J.D., C.B.), Yale School of Medicine, New Haven, CT., Chui PW; Department of Internal Medicine, Division of Cardiovascular Medicine (L.R., R.L., A.E.G., P.W.C., C.E.C., M.M.B.), Yale School of Medicine, New Haven, CT.; VA Connecticut Healthcare System, West Haven (J.J.S., A.E.G., P.W.C., C.E.C., C.B., S.H.)., Cavanagh CE; Department of Internal Medicine, Division of Cardiovascular Medicine (L.R., R.L., A.E.G., P.W.C., C.E.C., M.M.B.), Yale School of Medicine, New Haven, CT.; VA Connecticut Healthcare System, West Haven (J.J.S., A.E.G., P.W.C., C.E.C., C.B., S.H.)., Brandt C; Yale Center for Medical Informatics (C.M.R., C.B.), Yale School of Medicine, New Haven, CT.; Department of Emergency Medicine (C.M.R., J.D., C.B.), Yale School of Medicine, New Haven, CT.; VA Connecticut Healthcare System, West Haven (J.J.S., A.E.G., P.W.C., C.E.C., C.B., S.H.)., Haskell S; Department of Internal Medicine, Division of General Medicine (J.J.S., S.H.), Yale School of Medicine, New Haven, CT.; VA Connecticut Healthcare System, West Haven (J.J.S., A.E.G., P.W.C., C.E.C., C.B., S.H.)., Burg MM; Department of Internal Medicine, Division of Cardiovascular Medicine (L.R., R.L., A.E.G., P.W.C., C.E.C., M.M.B.), Yale School of Medicine, New Haven, CT.; Department of Anesthesiology (M.M.B.), Yale School of Medicine, New Haven, CT.
Jazyk: angličtina
Zdroj: Stroke [Stroke] 2019 Nov; Vol. 50 (11), pp. 2996-3003. Date of Electronic Publication: 2019 Oct 17.
DOI: 10.1161/STROKEAHA.119.026854
Abstrakt: Background and Purpose- In older populations, transient ischemic attack (TIA) and ischemic stroke have been linked to psychological factors, including posttraumatic stress disorder (PTSD). Whether PTSD also increases risk for early incident stroke in young adults is unknown. Methods- We prospectively assessed the incidence of TIA and ischemic stroke in a cohort of 987 855 young and middle-aged Veterans (mean age of 30.29±9.19 years; 87.8% men, 64.4% white) who first accessed care through the Veterans Health Administration from October 2001 to November 2014 and were free of TIA and ischemic stroke at baseline. For each outcome, time-varying multivariate Cox models were constructed to examine the effect of PTSD on incident stroke. We also assessed for effect modification by sex. Additional sensitivity analyses controlled for healthcare utilization. Results- Over a 13-year period, TIA and ischemic stroke were diagnosed in 766 and 1877 patients, respectively. PTSD was diagnosed in 28.6% of the sample during follow-up. In unadjusted analyses, PTSD was significantly associated with new-onset TIA (hazard ratio [HR], 2.02; 95% CI, 1.62-2.52) and ischemic stroke (HR, 1.62; 95% CI, 1.47-1.79). In fully adjusted models, the association between PTSD and incident TIA (HR, 1.61; 95% CI, 1.27-2.04) and ischemic stroke (HR, 1.36; 95% CI, 1.22-1.52) remained significant. The effect of PTSD on ischemic stroke risk was stronger in men than in women (HR, 0.63; 95% CI, 0.47-0.86; P =0.003), but no effect of sex was found for TIA. Conclusions- PTSD is associated with a significant increase in risk of early incident TIA and ischemic stroke independent of established stroke risk factors, coexisting psychiatric disorders, and healthcare utilization. Sex moderated the relationship for adults with ischemic stroke but not TIA. These findings suggest that psychological factors, including PTSD, may be important targets for future age-specific prevention strategies for young adults.
Databáze: MEDLINE