One in eight people who experience a heart attack or other life-threatening cardiac event may eventually develop some symptoms of post-traumatic stress disorder (PTSD), according to an analysis of multiple studies.
Furthermore, patients who develop full-blown PTSD have twice the risk of experiencing another heart attack or dying within one to three years, compared to those without PTSD.
PTSD is an anxiety disorder that typically develops after exposure to a traumatic event such as war, disaster or assault. Symptoms include nightmares or other distressing reexperiencing of the event, avoidance of reminders of the event, insomnia, hypervigilance and increased heart and blood pressure.
“The underlying similarity between heart attacks, combat experiences, even witnessing other people going through violence is that the individual perceives his or her own life is in danger,” said the study’s lead author, Donald Edmondson, Ph.D., assistant professor of behavioral medicine at Columbia University Medical Center. “The person experiences the threat of mortality and feels out of control.”
The analysis included a look at 24 separate studies involving more than 2,300 people worldwide. Researchers found that about 12 percent of people develop clinically significant symptoms of PTSD, while 4 percent meet full diagnostic criteria for the disorder.
Since approximately 1.4 million people in the U.S. experience an acute cardiac event per year, this would mean that 168,000 patients will develop clinically significant PTSD symptoms as a result – and most will go unrecognized, according to Edmondson.
“There have been studies that have looked at this before, but most of those used very small samples [of people],” Edmondson explained. “When we ask what the prevalence is in 2,300 patients, that’s when people sit up and take notice. There’s an issue here – this is something we need to pay attention to.”
Three of the studies in the analysis, which included a total of 600 patients, revealed that heart attack patients with PTSD had double the risk of suffering another heart attack or dying within a few years.
“It’s not just a quality of life issue, but a quantity of life issue – that’s also something that makes the medical community take notice,” Edmonson said.
Although there are no proven explanations as to why PTSD raises the risk of death among heart patients, Edmondson said researchers do offer a couple of hypotheses. One is focused on the physiological response linked to PTSD, which raises activity of the automatic nervous system and leads to inflammation in the body.
“Inflammation in the system is central to heart disease,” Edmondson explained. “It leads to clogging of the arteries.”
Another hypothesis is based on the behavioral responses of PTSD patients. Previous studies on patients who have suffered strokes and other life-threatening medical events show that PTSD may be associated with failure to take secondary prevention medications.
“What may be happening is the patients are avoiding reminders of traumatic events,” Edmondson said. “While the medications in reality are there to help, psychologically they may function as a reminder of the initial heart attack, so patients avoid that by skipping the medications or forgetting to take them.”
For heart patients with PTSD, a recent study has shown that one of the most popular PTSD treatments – talk therapy – appears to be safe and effective.
“I have three classes of takeaways,” Edmondson said, “For the patient, if you’re having intrusive recollections of trauma or having nightmares or you feel keyed up, you’re not strange. This is not some weird thing – it’s something we understand, it’s treatable.
“For family members, social support is the big key. Just because it’s over for family members, and the patient is out of physical danger, it doesn’t mean it’s over psychologically. Be on the lookout for things like sleep disturbance.”
And finally, for cardiologists, Edmondson said awareness was crucial. “Cardiologists have been on the cutting edge of behavioral medicine for a long time,” he said. “We learned years ago people get depressed after heart attacks and now, every cardiologist will list off depression as a risk factor after heart attacks. So they’re open to this information; they just haven’t had it before.”
“We got burnt in the academic community on screening everyone for things like prostate cancer or breast cancer, so I don’t recommend screening everyone because it’s possible that you can overtreat sometimes, but awareness is more warranted,” he said.
The study is published in the journal PLoS One.
Source: PLoS One