Maladaptive Health Factors as Mediators of the Association Between Posttraumatic Stress Disorder and Cardiovascular Disease: A Sex-Stratified Analysis in the U.S. Adult Population

Objectives: Despite a higher prevalence of posttraumatic stress disorder (PTSD) and greater severity and chronicity of cardiovascular disease (CVD) in females than males, sex-differences in explanations for the PTSD-CVD relationship are lacking. This study examined sex-differences in the role of health risk factors in mediating the relationship between PTSD and CVD.Methods: Data were analyzed from the 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions, which surveyed a nationally representative sample of 36,309 U.S. adults. Natural effect models and logistic regression analyses were conducted to evaluate the potential effects of each health risk factor (smoking, low physical activity, high body mass index [BMI], binge eating, multiple health risk factors) in mediating the relation between PTSD and CVD. Parallel analyses of each model were conducted in females and males.Results: High BMI independently mediated the PTSD-CVD relationship in females (indirectAOR = 1.05, 95% CI = 1.02, 1.07) though not males. Binge eating, smoking and low physicalactivity were not found to mediate this relationship in either sex. The number of health risk factors also mediated this relationship in both sexes (indirect AOR = 1.14, 95% CI = [1.08,1.19] for females; indirect AOR = 1.16, 95% CI = [1.07, 1.26] for males).Conclusions: The results may inform the development of secondary prevention strategies, such as screening for health risk factors to mitigate the adverse effect of PTSD on CVD risk. Further, the findings may inform early intervention strategies designed to reduce risk of PTSD and CVD, such as addressing high BMI in females and the cumulative burden of health risk behaviours inboth sexes through psychological treatments.