Posttraumatic Stress Disorder May Increase Risk for Stroke, TIA in Young Adults

The risk for early incident transient ischemic attack (TIA) and ischemic stroke is significantly higher in young adults with posttraumatic stress disorder (PTSD), according to study results published in Stroke.

“Stroke has a devastating impact on young patients and their families, many of whom

struggle to cope with long-term disability, depression and economic loss during their most productive years,” said Lindsey Rosman, PhD, lead study investigator and assistant professor of medicine in the division of cardiology at the University of North Carolina School of Medicine in Chapel Hill. “Ten to 14% of ischemic strokes occur in adults ages 18 to 45, and we don’t really have a good understanding of the risk factors for stroke in this age group.”

Previous studies have shown that PTSD is more common in younger patients and may be significantly associated with the risk for cerebrovascular disease. While stress and trauma symptoms have been associated with stroke in older adults, it is unclear whether this applies to young adults. The goal of this study was to explore the association between PTSD and incident TIA and ischemic stroke in young and middle-aged US service members who were deployed to Iraq and Afghanistan.

The prospective study included 987,855 veterans (mean age 30.29±9.19 years; 87.8% men). At baseline, all participants were free of TIA and ischemic stroke.

Between October 2001 and November 2014, a total of 766 patients were diagnosed with TIA and 1877 were diagnosed with ischemic stroke. Diagnosis of PTSD during the follow-up was evident in 28.6% of the overall sample.

In unadjusted models, PTSD was associated with a 2-fold increased risk for TIA (hazard ratio [HR], 2.02; 95% CI, 1.62 to 2.52) as well as increased risk for ischemic stroke (HR, 1.62; 95% CI 1.47-1.79). This association remained significant following adjustment for known risk factors for stroke and psychiatric comborbidities (HR, 1.61; 95% CI 1.27 to 2.04; and HR, 1.36; 95% CI, 1.22 to 1.52).

Fully adjusted survival models showed a significant interaction of PTSD by gender for CVA (HR, 0.63; 95% CI, 0.47 to 0.86, P =.003), implying the risk for stroke was higher in men with PTSD compared with women with PTSD. There was, however, no interaction between PTSD and gender for TIA.

The researchers noted the study had several limitations, including its observational design; sample limited to post-9/11 veterans, thereby limiting the generalizability to other populations; insufficient number of older adults to complete analyses by age; and no data on the PTSD treatment effect on stroke risk.

“Clinicians should be aware that mental health conditions such as PTSD are increasingly

prevalent among young people and may have major implications for their risk of stroke,” noted Rosman. “Our findings raise important questions about whether early recognition and successful treatment of PTSD can prevent or decrease the likelihood of developing stroke in those exposed to violence, trauma and severe adversity.”

Reference

1. Rosman L, Sico JJ, Lampert R, et al. Posttraumatic stress disorder and risk for stroke in young and middle-aged adults: a 13-year cohort study [published online September 20, 2019]. Stroke. doi:10.1161/STROKEAHA.119.026854

2. American Heart Association. Young adults with PTSD may have a higher risk of stroke in middle age. [press release]. Dallas, Texas:  October 17, 2019. https://newsroom.heart.org/news/young-adults-with-ptsd-may-have-a-higher-risk-of-stroke-in-middle-age. Accessed October 17, 2019.