Objectives associated with aging-related health PTSD affects 1 in - - PDF document

9/24/18 1

Increased Risk for Cardiovascular Disease Among Postmenopausal Women with Diabetes and Comorbid Posttraumatic Stress Disorder

Carolyn Gibson, PhD, MPH

San Francisco VA Health Care System and University of California, San Francisco NAMS Annual Meeting, October 5, 2018 The views expressed in this presentation are those of the authors and do not necessarily reflect the position

• r policy of the Department of Veterans Affairs or the

United States government. No conflicts of interest to report.

PTSD is common, often chronic, and associated with aging-related health

• PTSD affects 1 in 10 women
• PTSD associated with aging-related health,

including diabetes, cardiovascular disease

• Diabetes comorbid with depression is more

strongly linked to CVD morbidity, mortality than either alone. Similar pattern with PTSD?

Objectives

1) Examine independent associations between PTSD, diabetes, and incident CVD. 2) Examine additive associations between comorbid PTSD and diabetes and incident CVD.

9/24/18 2 Study design

• Retrospective cohort study
• National VA medical record data for women

Veterans aged 55 and older

• 1+ VA encounter during baseline (2008-2011)

and follow-up (2012-2015)

Statistical Analyses

PTSD diabetes Incident CVD

2008-2011 2012-2015 Fine-Gray proportional hazards models adjusted for age, education, income, hypertension, hyperlipidemia, obesity

Statistical Analyses

PTSD diabetes Incident CVD

2008-2011 2012-2015 Fine-Gray proportional hazards models adjusted for age, education, income, hypertension, hyperlipidemia, obesity

Statistical Analyses

PTSD diabetes Incident CVD

2008-2011 2012-2015 Fine-Gray proportional hazards models adjusted for age, education, income, hypertension, hyperlipidemia, obesity

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Sample characteristics

N=150,791 Age (mean, SD) 62.64 (8.0) >25% college-educated 42% Median income tertile Low 31% Middle 31% High 33% Hypertension 44% Hyperlipidemia 44% Obesity 24%

Sample characteristics

2 4 6 8 10 12 14 16 18 20

PTS D Diabetes PTS D + Di abetes CVD

9% 17% 2% 12% PTSD Diabetes PTSD + Diabetes Incident CVD 2008-2011 2012-2015

PTSD Diabetes

HR (95% CI)

1 1.5 2.0 2.5

PTSD and diabetes are associated with incident CVD

Risk for incident CVD, adjusted for age, education, income, hypertension, hyperlipidemia, obesity 1.47 (1.38-1.57) 1.49 (1.44-1.55)

PTSD Diabetes

HR (95% CI)

1 1.5 2.0 2.5

Risk for incident CVD, adjusted for age, education, income, hypertension, hyperlipidemia, obesity

PTSD + Diabetes

Two-fold risk for incident CVD with comorbid PTSD and diabetes

1.47 (1.38-1.57) 1.49 (1.44-1.55) 1.96 (1.80-2.12)

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Strengths and Limitations

• Veteran VA users may not be generalizable to

non-VA users, civilians

• ICD-9 codes: Diagnoses may be

underrepresented; validity, chronicity, severity, and some temporal relationships unknown

• Information about PTSD treatment unknown

Conclusions

• PTSD is an underrecognized risk factor for CVD

and aging-related health in older women

• PTSD may augment diabetes-related CVD risk
• Clinicians need to recognize prevalence and

impact of PTSD among older women in chronic disease prevention and management

Thank you!

Yixia Li, MPH Sabra Inslicht, PhD Karen Seal, MD, MPH Amy Byers, PhD, MPH

Research supported in part by the VA Advanced Fellowship Program in Women's Health at the San Francisco VA Health Care System and VA HSR&D CDA 17-018 (CJG).