Key result
PTSD linked to ~16% higher risk of MACE.
Why the study?
Prior research linking PTSD to increased cardiovascular disease risk largely focused on US male veterans, leaving data from other settings and populations scarce.
Does post-traumatic stress disorder increase the risk of incident major adverse cardiovascular events in South African medical insurance scheme beneficiaries aged 18 years or older?
Cohort (n=1,009,113)
Does post-traumatic stress disorder increase the risk of incident major adverse cardiovascular events in South African medical insurance scheme beneficiaries aged 18 years or older?
Effect estimate: aHR 1.16 (95% CI 1.05-1.28)
Absolute Event Rate: 5.9% vs 3.9%
PTSD is an independent risk factor for major adverse cardiovascular events in a general South African population, emphasizing the need for cardiovascular risk monitoring in this group.
PTSD may warrant cardiovascular risk monitoring in affected patients; leaves open causal effects and intervention benefits in this population.
AIMS: Prior research, largely focused on US male veterans, indicates an increased risk of cardiovascular disease among individuals with post-traumatic stress disorder (PTSD). Data from other settings and populations are scarce. The objective of this study is to examine PTSD as a risk factor for incident major adverse cardiovascular events (MACEs) in South Africa. METHODS: We analysed reimbursement claims (2011-2020) of a cohort of South African medical insurance scheme beneficiaries aged 18 years or older. We calculated adjusted hazard ratios (aHRs) for associations between PTSD and MACEs using Cox proportional hazard models and calculated the effect of PTSD on MACEs using longitudinal targeted maximum likelihood estimation. RESULTS: We followed 1,009,113 beneficiaries over a median of 3.0 years (IQR 1.1-6.0). During follow-up, 12,662 (1.3%) persons were diagnosed with PTSD and 39,255 (3.9%) had a MACE. After adjustment for sex, HIV status, age, population group, substance use disorders, psychotic disorders, major depressive disorder, sleep disorders and the use of antipsychotic medication, PTSD was associated with a 16% increase in the risk of MACEs (aHR 1.16, 95% confidence interval (CI) 1.05-1.28). The risk ratio for the effect of PTSD on MACEs decreased from 1.59 (95% CI 1.49-1.68) after 1 year of follow-up to 1.14 (95% CI 1.11-1.16) after 8 years of follow-up. CONCLUSION: Our study provides empirical support for an increased risk of MACEs in males and females with PTSD from a general population sample in South Africa. These findings highlight the importance of monitoring cardiovascular risk among individuals diagnosed with PTSD.
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Mesa-Vieira et al. (2024) conducted a cohort in Post-traumatic stress disorder (PTSD) (n=1,009,113). Post-traumatic stress disorder (PTSD) vs. No PTSD was evaluated on Major adverse cardiovascular events (MACE) including myocardial infarction, stroke, or hospitalization for unstable angina or revascularization (aHR 1.16, 95% CI 1.05-1.28). Post-traumatic stress disorder was associated with a 16% increased risk of major adverse cardiovascular events (aHR 1.16) compared to individuals without PTSD in a South African cohort.
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