Stress from traumatic events linked to heart attacks

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Stress-related disorders may be linked to a heightened risk of cardiovascular disease (CVD), according to a large Swedish study, “Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study”published in The BMJ.

The risk of severe and acute CVD events, such as cardiac arrest and heart attack, was particularly high in the first 6 months after diagnosis of a stress-related disorder, and within the first year for other types of CVD. 

Researchers used Swedish population and health registers to explore the role of clinically diagnosed post-traumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions in the development of CVD. They controlled for family background, medical history and underlying psychiatric conditions. 

The researchers matched over 136,000 people from an “exposed cohort” who were diagnosed with a stress-related disorder between January 1987 and December 2013 with over 171,000 full siblings who were free of stress-related disorders and CVD. 

For each exposed person, 10 people from the general population who were unaffected by stress-related disorders and CVD at the date of diagnosis of the exposed patient were randomly selected. Exposed and unexposed people were then individually matched by birth year and sex. 

Severe stress reactions to significant life events or trauma were linked to a heightened risk of several types of CVD, especially during the first year after diagnosis, with a 64% higher risk among people with a stress-related disorder compared with their unaffected sibling. 

The findings were similar for people with a stress-related disorder compared with the general population. And there was a stronger link between stress-related disorders and early onset CVD – cases of disease that developed before the age of 50 years – than later onset ones. 

Out of all studied cases of CVD, the excess risk during the first year was strongest for heart failure and for major blood clots (embolism and thrombosis). There were similar associations across sex, calendar period, medical history and family history of CVD, but patients who were diagnosed with a stress disorder at a younger age had a heightened risk of CVD.