Symptoms of PTSD after MI may exacerbate risk for ischemia
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Patients who develop PTSD after MI are more prone to stress-induced myocardial ischemia than patients who did not develop PTSD.
Moreover, this relationship may indicate an underlying mechanism for elevated CV risk among patients with PTSD, researchers reported in JAMA Network Open.
To assess mental stress, patients with MI within 8 months before enrollment (mean age, 51 years; 49% women; 65% black; 15% with PTSD) underwent single-photon emission CT at rest, after mental stress testing using a standardized public speaking task and a conventional stress test using the Bruce protocol or pharmacologic testing with regadenoson (Lexiscan, Astellas). PTSD diagnosis was assessed using the Structured Clinical Interview from the Diagnostic and Statistical Manual of Mental Disorders and the civilian version of the PTSD Symptom Checklist.
Researchers found that the development of PTSD in the cohort was associated with greater incidence for stress-induced myocardial ischemia compared with patients without PTSD (27.3% vs. 14.7%; P = .04) and a greater mean number of ischemic segments (PTSD, 1.2; 95% CI, 0.5-1.8; no PTSD, 0.5; 95% CI, 0.3-0.7). However, there was no difference between groups for conventional stress ischemia (PTSD, 22.7%; no PTSD, 23.2%; P = .91).
Moreover, elevated levels of PTSD symptoms conferred greater odds for stress-induced myocardial ischemia (adjusted OR per 5-point score increase = 1.18; 95% CI, 1.04-1.35) but not with conventional stress (aOR per 5-point score increase = 1.05; 95% CI, 0.92-1.21).
Of the items covered by the PTSD Symptom Checklist, reexperiencing trauma was the symptom most strongly associated with stress-induced myocardial ischemia (aOR per 5-point score increase = 1.87; 95% CI, 1.21-2.91); second was avoidance and numbing symptoms (aOR per 5-point score increase = 1.51; 95% CI, 1.07-2.14), the researchers wrote.
“In a well-characterized sample of survivors of a recent MI, we showed that patients with PTSD were nearly twice as likely as those without PTSD to develop mental stress-induced myocardial ischemia, but not conventional stress-induced myocardial ischemia,” Bruno B. Lima, MD, PhD, cardiology fellow at Emory University, and colleagues wrote. “Furthermore, worse PTSD symptoms, especially on the symptom subscales of reexperiencing trauma and avoidance and numbing, were associated with an increase in the odds of developing mental stress-induced myocardial ischemia, but not conventional stress-induced myocardial ischemia. These findings were independent of clinical and behavioral risk factors.”
Effects of daily mental stress
The researchers noted that although determining the underlying mechanism linking PTSD to mental stress-induced myocardial ischemia among patients who have survived MI requires further investigation, the findings of this study imply that in their daily life, patients may experience episodes of mental stress that may result in incidences of silent myocardial ischemia.
“With this study, we found that myocardial ischemia under stress is frequent in these patients. This finding has a number of implications,” Cardiology Today Editorial Board Member Viola Vaccarino, MD, PhD, Wilton Looney professor of cardiovascular research of the department of epidemiology at the Rollins School of Public Health at Emory University, told Healio. “Myocardial ischemia could drive increased morbidity and mortality in these patients. Prompt recognition and improvement of PTSD symptoms in patients who have had an MI should help their heart health in addition to their mental health. Stress reduction techniques such as relaxation, biofeedback, meditation and regular physical activity are highly recommended in these patients. Patients who experience severe symptoms of PTSD or other serious mental health problems, however, should be referred to specialist care.”
Future research
“Medications or other interventions need to be studied to address their efficacy in reducing mental stress induced ischemia in post-MI patients with PTSD,” Vaccarino said in an interview. “In addition, we tested the patients in the lab; it is likely that they experience this problem during everyday life when exposed to stress, like when they experience reminders of their trauma, which is a common symptom of PTSD. This needs further study.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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