Post-traumatic stress disorder: When fear strikes the heart

Over the course of a lifetime, many people directly experience or witness harrowing events. These include serious car accidents, violent personal trauma (including sexual assault), natural or human-made disasters, and military combat. Life-threatening health conditions — such as a sudden cardiac arrest, a devastating stroke, or any illness that requires a prolonged stay in the ICU — can also leave people traumatized.

As many as one in five people with such histories experience short-term post-traumatic stress disorder (PTSD). This debilitating mental health condition is characterized by recurrent, frightening episodes during which people relive the traumatic event. Some go on to develop long-term symptoms (see “Understanding PTSD”). Over all, about 8% of all people will develop PTSD during their lifetime, which may leave them vulnerable to other health problems.

“There’s growing evidence from large, population-based studies linking PTSD to cardiovascular disease,” says cardiologist Dr. Christopher O’Donnell, professor of medicine at Harvard Medical School. But because many factors closely linked to heart disease—such as smoking, high blood pressure, and diabetes — are also common in people with PTSD, it’s been hard to untangle the true nature of the association, he adds.

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In 2018, the National Heart, Lung, and Blood Institute convened a workshop to review the current evidence and offer guidance for future research. Dr. O’Donnell and 14 other experts summarized the workshop findings in an article published July 14, 2021, in JAMA Cardiology.

Understanding PTSDMention PTSD, and most people immediately think of war veterans — with good reason. According to the National Center for PTSD, 12% of veterans of the wars in the Persian Gulf, Iraq, and Afghanistan have PTSD in a given year. And as many as 30% of Vietnam veterans have experienced PTSD at some point. But PTSD can affect people of all ages who have experienced any kind of trauma. Women are more likely to develop PTSD than men, and genetic differences may predispose some people to the disorder.It’s normal to have upsetting memories, feel on edge, and have trouble sleeping after a disturbing event. But if symptoms last more than a few months, you might have PTSD.Key symptoms include recurrent, vivid recollections or intrusive thoughts about a traumatic experience withdrawing from people and avoiding certain situations feeling emotionally disoriented or insensitivesteering clear of any reminders of the event or having a hard time recalling trouble sleeping being easily startled or overly wary. If PTSD symptoms disrupt your life for more than a few weeks, seek help from a licensed mental health professional. Keep in mind, too, that sometimes the symptoms don’t occur until six months or more after the triggering event. The U.S. Department of Veterans Affairs has more information; see

Possible mechanisms

Several mechanisms could explain why PTSD may leave people more prone to heart attacks and related problems. Stress activates the amygdala, the brain region involved in processing anxiety and fear. That triggers a release of white blood cells from the bone marrow, which is helpful when acute stress is related to an infection. But repeated or chronic stress can persistently elevate white blood cell counts, leading to inflammation, a process that encourages clogged heart arteries (atherosclerosis).

In stressful situations, your body also releases hormones that boost your heart rate and blood pressure. “In people with PTSD, these classic fight-or-flight reactions are revved up and repeated,” says Dr. O’Donnell. In addition, two common PTSD symptoms — disrupted sleep and social isolation — are known to raise heart disease risk.

Future research

Launched in 2011, the Million Veteran Program (MVP) is a national program that aims to discover how genes, lifestyle, and military exposure affect health and disease. “So far, more than 850,000 veterans have enrolled in the study, which is examining the genetics and epidemiology of PTSD, cardiovascular disease, and their shared, related risks,” says Dr. O’Donnell, who was chief scientist of the MVP from 2015 to 2021. Going forward, he hopes that major cardiovascular studies will include questions about PTSD to better clarify how it affects the heart and pinpoint therapies that may improve both PTSD and heart health.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

“If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!” – Matthew 7:11

 “A cheerful heart is good medicine, but a crushed spirit dries up the bones.” – Proverbs 17:22

 “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.” – Philippians 4:6

 “Above all else, guard your heart, for everything you do flows from it.” – Proverbs 4:23

 “For God has not given us a spirit of fear, but of power and of love and of a sound mind.” – 2 Timothy 1:7

 “Consider it pure joy, my brothers and sisters,[a] whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance.” – James 1:2-3

 “In all your ways acknowledge him, and he will make straight your paths.” – Proverbs 3:6

 “Commit your actions to the LORD, and your plans will succeed.”- Proverbs 16:3

 “Consider the ravens: They do not sow or reap, they have no storeroom or barn; yet God feeds them. And how much more valuable you are than birds!” Luke 12:24 – Luke 12:24

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