scholarly journals Combined effect of posttraumatic stress disorder and prescription opioid use on risk of cardiovascular disease

2019 ◽  
Vol 27 (13) ◽  
pp. 1412-1422 ◽  
Author(s):  
Jeffrey F Scherrer ◽  
Joanne Salas ◽  
Patrick Lustman ◽  
Peter Tuerk ◽  
Sarah Gebauer ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Opioid Analgesic ◽  
Hazard Ratio ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Increased Risk ◽  
Exposure Variable

Aim Prescription opioid analgesic use (OAU) is associated with increased risk of cardiovascular disease (CVD). OAU is more common in patients with than without posttraumatic stress disorder (PTSD), and PTSD is associated with higher CVD risk. We determined whether PTSD and OAU have an additive or multiplicative association with incident CVD. Methods and results Veterans Health Affairs patient medical record data from 2008 to 2015 was used to identify 2861 patients 30–70 years of age, free of cancer, CVD and OAU for 12 months before index date. We defined a four-level exposure variable: 1) no PTSD/no OAU, 2) OAU alone, 3) PTSD alone and 4) PTSD+OAU. Cox proportional hazard models estimated the association between the exposure variable and incident CVD. The mean age was 49.0 (±11.0), 85.7% were male and 58.3% were White, 34.4% had no PTSD/no OAU, 32.9% had PTSD alone, 10.6% had OAU alone, and 22.1% had PTSD+OAU. Compared with patients with no PTSD/no OAU, those with PTSD alone were not at increased risk of incident CVD (hazard ratio = 0.82; 95% confidence interval (CI): 0.63–1.17); however, OAU alone and PTSD+OAU were both significantly associated with incident CVD (hazard ratio = 1.99; 95% CI:1.36–2.92 and hazard ratio = 2.20; 95% CI: 1.61–3.02). There was no significant additive or multiplicative PTSD and OAU association with incident CVD. Conclusion OAU is associated with nearly a two-fold increased risk of CVD in patients with and without PTSD. Despite no additive or multiplicative interaction effects, the high prevalence of OAU in PTSD may represent a novel contributor to the elevated CVD burden among patients with PTSD.

scholarly journals Early onset neurocirculatory response to static handgrip is associated with greater blood pressure variability in women with posttraumatic stress disorder

2020 ◽  
Vol 318 (1) ◽  
pp. H49-H58 ◽  
Author(s):  
Jeung-Ki Yoo ◽  
Mark B. Badrov ◽  
Rosemary S. Parker ◽  
Elizabeth H. Anderson ◽  
Jessica L. Wiblin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Posttraumatic Stress Disorder ◽  
Muscle Contraction ◽  
Posttraumatic Stress ◽  
Early Onset ◽  
Stress Disorder ◽  
Muscle Sympathetic Nerve Activity ◽  
Pressor Responses ◽  
Increased Risk

Posttraumatic stress disorder (PTSD) is a psychiatric illness that is more prevalent in women, and accumulating evidence suggests a link between PTSD and future development of cardiovascular disease. The underlying mechanisms are unclear, but augmented sympathetic reactivity to daily stressors may be involved. We measured muscle sympathetic nerve activity (MSNA), blood pressure (BP), and heart rate responses in 14 women with PTSD and 14 healthy women (controls) during static handgrip (SHG) exercise to fatigue at 40% of maximal voluntary contraction (MVC). Two minutes of postexercise circulatory arrest (PECA) was followed immediately after SHG to fatigue. MVC and the time to fatigue during SHG did not differ between groups (both P > 0.05). At the first 30 s of SHG, women with PTSD showed augmented sympathetic neural [mean ± SD, ∆MSNA burst frequency (BF): 5 ± 4 vs. 2 ± 3 bursts/30 s, P = 0.02 and ∆MSNA total activity (TA): 82 ± 58 vs. 25 ± 38 arbitrary units/30 s, P = 0.004] and pressor (∆systolic BP: 10 ± 5 vs. 4 ± 3 mmHg, P = 0.003) responses compared with controls. However, MSNA and BP responses at fatigue and during PECA were not different between groups. More interestingly, the augmented initial neural and pressor responses to SHG were associated with greater awake systolic BP variability during ambulation in women with PTSD (MSNA BF: r = 0.55, MSNA TA: r = 0.62, and SBP: r = 0.69, all P < 0.05). These results suggest that early onset exercise pressor response in women with PTSD may be attributed to enhanced mechano- rather than metaboreflexes, which might contribute to the mechanisms underlying the link between PTSD and cardiovascular risk. NEW & NOTEWORTHY The novel findings of the current study are that women with posttraumatic stress disorder (PTSD) exhibited augmented sympathetic neural and pressor responses at the first 30 s of submaximal isometric muscle contraction. More interestingly, exaggerated neurocirculatory responses at the onset of muscle contraction were associated with greater ambulatory awake systolic blood pressure fluctuations in women with PTSD. Our findings expand the knowledge on the physiological mechanisms that perhaps contribute to increased risk of cardiovascular disease in such a population.

scholarly journals Co-occurring prescription opioid use problems and posttraumatic stress disorder symptom severity

2014 ◽  
Vol 40 (4) ◽  
pp. 304-311 ◽  
Author(s):  
Andrea Meier ◽  
Chantal Lambert-Harris ◽  
Mark P. McGovern ◽  
Haiyi Xie ◽  
Melissa An ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Symptom Severity ◽  
Stress Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Disorder Symptom ◽  
Prescription Opioid Use

Reduced left ventricular diastolic function in women with posttraumatic stress disorder

2019 ◽  
Vol 317 (1) ◽  
pp. R108-R112 ◽  
Author(s):  
Michinari Hieda ◽  
Jeung-Ki Yoo ◽  
Mark B. Badrov ◽  
Rosemary S. Parker ◽  
Elizabeth H. Anderson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Posttraumatic Stress Disorder ◽  
Diastolic Function ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Left Ventricular ◽  
Control Group ◽  
Increased Risk ◽  
Lv Diastolic Function ◽  
Ptsd Group

Women are two to three times more likely to develop posttraumatic stress disorder (PTSD) compared with men after exposure to a major trauma, and PTSD is associated with increased risk for cardiovascular disease in later life. The underlying mechanisms are unclear, but alterations in cardiac function may be involved. We hypothesized that women with PTSD have reduced left ventricular (LV) diastolic function. We studied 14 women with PTSD (PTSD group) and 14 women without PTSD (controls) using echocardiography Doppler to evaluate LV diastolic function, including peak velocities (E and A waves) in transmitral flow; diastolic, atrial kick, and systolic waveform velocities (e′, a′, and s′) in tissue Doppler; the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e′); and velocity of propagation ( Vp) . Baseline characteristics including age, body size, blood pressure, and heart rate were not significantly different between the two groups. Compared with the control group, women with PTSD showed greater E/e′ (controls vs. PTSD group: 7.0 ± 1.3 vs. 9.1 ± 1.3, P = 0.002) and smaller Vp (controls vs. PTSD group: 63.7 ± 11.3 vs. 47.5 ± 6.9 cm/s, P = 0.003). These results suggest that women with PTSD have reduced LV diastolic function, which may contribute, at least in part, to the increased risk of cardiovascular disease later in life.

Treatment Outcomes in Individuals Diagnosed with Comorbid Opioid Use Disorder and Posttraumatic Stress Disorder: A Review

2021 ◽  
pp. 107026
Author(s):  
Sarah Meshberg-Cohen ◽  
R. Ross MacLean ◽  
Ashley M. Schnakenberg Martin ◽  
Mehmet Sofuoglu ◽  
Ismene L. Petrakis
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Treatment Outcomes ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Opioid Use Disorder ◽  
Opioid Use

Abstract P127: Posttraumatic Stress Disorder and Risk for Coronary Heart Disease: A Meta-analytic Review

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Donald Edmondson ◽  
Ian M Kronish ◽  
Jonathan A Shaffer ◽  
Louise Falzon ◽  
Matthew M Burg
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Forest Plot ◽  
Increased Risk ◽  
Analytic Review

Context: Recent evidence suggests that posttraumatic stress disorder (PTSD) may be associated with increased risk for coronary heart disease (CHD). Objective: To determine the association of PTSD to incident CHD using systematic review and meta-analysis. Data Sources: Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and through manual search of reference lists. Study Selection: Prospective cohort studies that assessed PTSD in participants free of CHD and assessed subsequent CHD or cardiac-specific mortality. Data Extraction: We extracted estimates of the association of PTSD to incident CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HR), and a random-effects model was used to pool results. Data Synthesis: Five studies met our inclusion criteria (N= 401,712); 4 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.53 (95% CI, 1.27-1.84) before adjustment for depression. The pooled HR estimate for the 4 depression-adjusted estimates (N= 362,388) was 1.22 (95% CI, 1.05-1.42). Conclusion: PTSD is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. Figure 1. Forest plot of association of PTSD to incident MI or cardiac mortality Note: The area of each square is proportional to the study’s weight in the meta-analysis, and each line represents the confidence interval around the estimate. The diamond represents the aggregate estimate, and its lateral points indicate confidence intervals for this estimate.

Prescription opioid use during pregnancy and risk for preterm birth or term low birthweight

2021 ◽  
Vol 17 (3) ◽  
pp. 215-225
Author(s):  
Julia D. Interrante, MPH ◽  
Stacey L. P. Scroggs, PhD ◽  
Carol J. Hogue, PhD ◽  
Jan M. Friedman, MD ◽  
Jennita Reefhuis, PhD ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Low Birthweight ◽  
Opioid Analgesic ◽  
Population Based ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Increased Risk ◽  
Potential Risks ◽  
Prescription Opioid Use

Objective: Examine the relationship between prescription opioid analgesic use during pregnancy and preterm birth or term low birthweight.Design, setting, and participants: We analyzed data from the National Birth Defects Prevention Study, a US multisite, population-based study, for births from 1997 to 2011. We defined exposure as self-reported prescription opioid use between one month before conception and the end of pregnancy, and we dichotomized opioid use duration by ≤7 days and 7 days.Main outcome measures: We examined the association between opioid use and preterm birth (defined as gestational age 37 weeks) and term low birthweight (defined as 2500 g at gestational age ≥37 weeks).Results: Among 10,491 singleton mother/infant pairs, 470 (4.5 percent) reported opioid use. Among women reporting opioid use, 236 (50 percent) used opioids for 7 days; codeine (170, 36 percent) and hydrocodone (163, 35 percent) were the most commonly reported opioids. Opioid use was associated with slightly increased risk for preterm birth [adjusted odds ratio, 1.4; 95 percent confidence interval, 1.0, 1.9], particularly with hydrocodone [1.6; 1.0, 2.6], meperidine [2.5; 1.2, 5.2], or morphine [3.0; 1.5, 6.1] use for any duration; however, opioid use was not significantly associated with term low birthweight.Conclusions: Preterm birth occurred more frequently among infants of women reporting prescription opioid use during pregnancy. However, we could not determine if these risks relate to the drug or to indications for use. Patients who use opioids during pregnancy should be counseled by their practitioners about this and other potential risks associated with opioid use in pregnancy. 

scholarly journals Depression and Psychosocial Stress Are Associated With Subclinical Carotid Atherosclerosis Among Women Living With HIV

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Matthew E. Levy ◽  
Kathryn Anastos ◽  
Steven R. Levine ◽  
Michael Plankey ◽  
Amanda D. Castel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Posttraumatic Stress Disorder ◽  
Depressive Symptoms ◽  
Posttraumatic Stress ◽  
Psychosocial Stress ◽  
Latent Class ◽  
Stress Disorder ◽  
Plaque Formation ◽  
Psychosocial Risk ◽  
Increased Risk

Background To identify reasons for increased atherosclerotic risk among women living with HIV ( WLWH ), we evaluated the associations between psychosocial risk factors (depressive symptoms, perceived stress, and posttraumatic stress disorder symptoms) and subclinical atherosclerosis among WLWH and HIV ‐negative women. Methods and Results Carotid artery focal plaque (localized intima‐media thickness >1.5 mm) was measured using B‐mode ultrasound imaging in 2004–2005 and 2010–2012 in the Women's Interagency HIV Study. We created psychosocial risk groups using latent class analysis and defined prevalent plaque at the final measurement. We also examined repeated semiannual depression measures with respect to focal plaque formation throughout follow‐up. The associations between latent class and prevalent plaque, and between depressive symptom persistence and plaque formation, were assessed separately by HIV status using multivariable logistic regression. Among 700 women (median age 47 years), 2 latent classes were identified: high (n=163) and low (n=537) psychosocial risk, with corresponding prevalence of depression (65%/13%), high stress (96%/12%), and probable posttraumatic stress disorder (46%/2%). Among WLWH , plaque prevalence was 23% and 11% in high versus low psychosocial risk classes (adjusted odds ratio [aOR], 2.12; 95% CI, 1.11–4.05) compared with 9% and 9% among HIV ‐negative women (aOR, 1.07; 95% CI, 0.24–4.84), respectively. New plaque formation occurred among 17% and 9% of WLWH who reported high depressive symptoms at ≥45% versus <45% of visits (aOR, 1.96; 95% CI, 1.06–3.64), compared with 9% and 7% among HIV ‐negative women (aOR, 0.82; 95% CI, 0.16–4.16), respectively. Conclusions Psychosocial factors were independent atherosclerotic risk factors among WLWH . Research is needed to determine whether interventions for depression and psychosocial stress can mitigate the increased risk of atherosclerosis for WLWH .

scholarly journals Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD

2020 ◽  
pp. 1-11 ◽  
Author(s):  
Sarah R. Lowe ◽  
Andrew Ratanatharathorn ◽  
Betty S. Lai ◽  
Willem van der Mei ◽  
Anna C. Barbano ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Multinomial Logistic Regression ◽  
Female Gender ◽  
Interpersonal Trauma ◽  
Demographic Characteristics ◽  
Ptsd Symptoms ◽  
Symptom Trajectories ◽  
Increased Risk

Abstract Background Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. Methods This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. Results Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. Conclusions The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.

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