The Impact of Late-Life PTSD on Vascular-Related Disorders


      Posttraumatic Stress Disorder (PTSD) is common among young veterans returning from Iraq and Afghanistan and has been highly prevalent in veterans across the lifespan and into late life. Although PTSD is associated with poor health outcomes in younger veterans, little is known about late-life PTSD and its association with adverse outcomes such as cerebrovascular disease and other vascular-related disorders. Since the risk of medical comorbidities increases with age, the impact of late-life PTSD on vascular disease may be daunting. To this end, the Veterans Affairs (VA) Veterans Health Administration Data provides an important resource to study a comprehensive list of vascular-related disorders and their relationship to late-life PTSD. As the largest national health care system, carefully collected data from VA medical centers on diagnoses of PTSD and confounding variables provides the power to test intricate and comprehensive models. The objective of the current study was to examine the association between PTSD and vascular-related disorders among older veterans. We determined whether late-life PTSD increased risk of vascular-related diagnoses over 8 years of follow up; assessing risk of vascular disorders.


      We evaluated data on a random sample of 200,000 veterans who were age 55 years or older using the VA National Patient Care Database, which captures all inpatient and outpatient services within the VA. Our study used baseline data from fiscal year 2000 to 2003, and follow-up data from fiscal year 2004 to 2011. Vascular-related conditions included cerebrovascular disease, peripheral vascular disease, congestive heart failure, and myocardial infarction identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes recorded in the VA database. Veterans with baseline vascular-related diagnoses were removed to analyze incident diagnoses at follow up; thus, the final sample was 138,341 veterans. PTSD was defined by ICD-9-CM codes at two or more visits during the baseline period. Demographic information (gender, education, and income) was captured from VA database records and census data. Other disorders such as diabetes, dementia, TBI, renal disease, depression, and substance use disorders were determined based on ICD-9-CM codes. Cox proportional hazard models were used to estimate hazard ratios for the longitudinal association between baseline PTSD and incident vascular disorders. Models were serially adjusted for demographics and the comorbid conditions.


      Unadjusted models revealed that veterans with late-life PTSD had significantly increased risk for incident cerebrovascular disease (HR: 1.80, 95% CI: 1.66-1.95), congestive heart failure (HR: 1.56, 95% CI: 1.42-1.72), myocardial infarction (HR: 1.82, 95% CI: 1.63-2.04), and peripheral vascular disease (HR: 1.60, 95% CI: 1.47-1.75). These associations remained significant in the fully-adjusted model (demographics, medical comorbidities, psychiatric disorders, and substance use disorders), where veterans with late-life PTSD were at 24% greater risk of cerebrovascular disease during 8-year follow up (HR: 1.24, 95% CI: 1.20-1.29) than veterans without late-life PTSD, and at 26% increased risk of congestive heart failure (HR: 1.26, 95% CI: 1.14-1.38), at almost 50% increased risk of myocardial infarction (HR: 1.49, 95% CI: 1.32-1.68), and at over 30% greater risk of peripheral vascular disease (HR: 1.34, 95% CI: 1.22-1.47).


      These findings support the longitudinal impact of PTSD on increasing the incidence of vascular disorders in older adults. This study suggests the need for greater monitoring and treatment of PTSD in older persons, particularly older veterans, to assist in the prevention of adverse outcomes, such as vascular disorders, over the long term.