Why PTSD Increases Your Risk of Having a Stroke

PTSD may heighten stroke risk in younger adults

Why PTSD Increases Your Risk of Having a Stroke
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Younger adults with post-traumatic stress disorder are more ly to have a stroke by middle age, according to a new study in veterans. The heightened risk in some cases surpasses that from well-known factors such as diabetes, obesity and smoking.

About 30% of veterans are affected by PTSD, but the condition can be triggered by more than combat. The trauma of observing or experiencing gun violence, sexual assault or a natural disaster may cause long-lasting symptoms such as anxiety, anger, flashbacks and nightmares. In all, PTSD afflicts nearly 8 million American adults.

“PTSD is not just a veteran issue, it's a serious public health problem,” the study's lead author, Lindsey Rosman, said in a news release. She's an assistant professor of medicine in the division of cardiology at the University of North Carolina School of Medicine in Chapel Hill.

Although PTSD has been shown to increase the risk of heart disease and stroke in older adults, this is the first study to link trauma-induced stress disorders with stroke-related risks in young and middle-age adults. That age group has experienced a striking increase in stroke over the past decade.

“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,” Rosman said. “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.”

In the study, published Thursday in the American Heart Association journal Stroke, researchers analyzed medical data from 1.1 million veterans who served in Iraq and Afghanistan. Most of the subjects were men, with an average age of 30, and most were white.

None had previously experienced a stroke or transient ischemic attack, also known as a mini-stroke. During 13 years of follow-up, 766 veterans had a TIA and 1,877 had an ischemic stroke, which occurs when a vessel supplying blood to the brain is obstructed.

The researchers found veterans with PTSD were twice as ly to have a TIA, raising the risk more than established factors such as diabetes and sleep apnea. Veterans with PTSD were 62% more ly to have a stroke, raising the risk more than lifestyle factors such as obesity and smoking.

Veterans with PTSD were more ly to engage in unhealthy behaviors, such as smoking and getting little exercise, which raise stroke risk.

But even after adjusting for multiple stroke risk factors, drug and alcohol abuse, and disorders such as depression and anxiety, veterans with PTSD were still 61% more ly to have a TIA than veterans without PTSD. They also were still 36% more ly to have a stroke.

The link between PTSD and stroke was stronger in men than in women.

Rosman suggested addressing mental health issues could be an important part of a broader public health initiative to reduce stroke in young people.

“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,” Rosman said.

“Our findings raise important questions about whether early recognition and successful treatment of PTSD can prevent or decrease the lihood of developing stroke in those exposed to violence, trauma and severe adversity.”

If you have questions or comments about this story, please email editor@heart.org. 

Source: https://www.heart.org/en/news/2019/10/17/ptsd-may-heighten-stroke-risk-in-younger-adults

Young adults with PTSD may have a higher risk of stroke in middle age

Why PTSD Increases Your Risk of Having a Stroke

Young adults who suffer from posttraumatic stress disorder (PTSD) may be more ly to experience a transient ischemic attack (TIA) or major stroke event by middle age, raising the risk as much as other better-known risk factors, according to new research published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

“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, Ph.D.

, lead author of the study 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.”

While PTSD has previously been shown to increase the risk of heart disease and stroke in older adults, this is the first study to demonstrate a link between trauma-induced stress disorders and the risk of TIA and stroke in young and middle-aged adults, an age group that has experienced a striking increase in stroke events over the past decade.

Although this study was conducted solely in veterans, PTSD is a debilitating mental condition that affects nearly 8 million adults in the U.S. and about 30 percent of veterans.

People who observe or directly experience a traumatic event such as sexual assault, gun violence/mass shooting, military combat or a natural disaster may develop long-lasting symptoms of anxiety, avoidance, hypervigilance, anger/irritability, flashbacks and nightmares.

“PTSD is not just a veteran issue, it's a serious public health problem,” Rosman said.

Researchers analyzed medical data from more than one million young and middle-aged veterans enrolled in healthcare services provided by the Veterans Health Administration (mostly males, age 18-60, average age of 30, 2 3 white) and had served in recent conflicts in Iraq and Afghanistan. None had previously experienced a TIA or stroke.

During 13 years of follow-up, 766 veterans had a TIA, and 1,877 had an ischemic stroke. Researchers also found:

  • 29% were diagnosed with PTSD, and veterans with PTSD were twice as ly to have a TIA, raising the risk more than established risk factors such as diabetes and sleep apnea.
  • Veterans with PTSD were 62% more ly to have a stroke, raising the risk more than lifestyle factors such as obesity and smoking.
  • Veterans with PTSD were more ly to engage in unhealthy behaviors, such as smoking and getting little exercise, that raise the rise for stroke.
  • Even after adjusting for multiple stroke risk factors, co-existing psychiatric disorders, such as depression and anxiety, as well as drug and alcohol abuse, veterans with PTSD were still 61% more ly to have a TIA and 36% more ly to have a stroke than veterans without PTSD.
  • There was a stronger link between PTSD and stroke in men than in women.

“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,” Rosman said.

“Our findings raise important questions about whether early recognition and successful treatment of PTSD can prevent or decrease the lihood of developing stroke in those exposed to violence, trauma and severe adversity.”

Although the study showed a strong relationship between PTSD and early TIA and stroke, it wasn't designed to prove that PTSD causes either condition. Additionally, because the analysis was conducted in younger veterans, the results may not be generalizable to non-veterans or older adults who may have more conventional stroke risk factors, such as atrial fibrillation and heart failure.

“We need to improve stroke prevention in young adults by developing targeted screening programs and age-appropriate interventions. Addressing mental health issues including PTSD may be an important part of a broader public health initiative to reduce the growing burden of stroke in young people,” Rosman said.

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Source: https://www.sciencedaily.com/releases/2019/10/191018181023.htm

Posttraumatic Stress Disorder and Risk for Stroke in Young and Middle-Aged Adults

Why PTSD Increases Your Risk of Having a Stroke

In older populations, transient ischemic attack (TIA) and ischemic stroke have been linked to psychological factors, including posttraumatic stress disorder (PTSD). Whether PTSD also increases risk for early incident stroke in young adults is unknown.

Methods—

We prospectively assessed the incidence of TIA and ischemic stroke in a cohort of 987 855 young and middle-aged Veterans (mean age of 30.29±9.19 years; 87.8% men, 64.

4% white) who first accessed care through the Veterans Health Administration from October 2001 to November 2014 and were free of TIA and ischemic stroke at baseline. For each outcome, time-varying multivariate Cox models were constructed to examine the effect of PTSD on incident stroke.

We also assessed for effect modification by sex. Additional sensitivity analyses controlled for healthcare utilization.

Results—

Over a 13-year period, TIA and ischemic stroke were diagnosed in 766 and 1877 patients, respectively. PTSD was diagnosed in 28.6% of the sample during follow-up. In unadjusted analyses, PTSD was significantly associated with new-onset TIA (hazard ratio [HR], 2.02; 95% CI, 1.62–2.52) and ischemic stroke (HR, 1.62; 95% CI, 1.47–1.79).

In fully adjusted models, the association between PTSD and incident TIA (HR, 1.61; 95% CI, 1.27–2.04) and ischemic stroke (HR, 1.36; 95% CI, 1.22–1.52) remained significant. The effect of PTSD on ischemic stroke risk was stronger in men than in women (HR, 0.63; 95% CI, 0.47–0.86; P=0.003), but no effect of sex was found for TIA.

Conclusions—

PTSD is associated with a significant increase in risk of early incident TIA and ischemic stroke independent of established stroke risk factors, coexisting psychiatric disorders, and healthcare utilization.

Sex moderated the relationship for adults with ischemic stroke but not TIA.

These findings suggest that psychological factors, including PTSD, may be important targets for future age-specific prevention strategies for young adults.

Young and middle-aged adults with cerebrovascular disease are a growing yet understudied population. Ten percent to 14% of ischemic strokes occur in adults aged 18 to 45 years and are associated with substantial morbidity, mortality, and healthcare expenditures.

1,2 Stroke has an especially 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.

3,4 In contrast to the generally decreasing trends observed in older adults, there has been a marked increase in the incidence of transient ischemic attack (TIA) and ischemic stroke in young adults during the past decade,5 suggesting an urgent need to improve risk factor identification and control in this age group.

Psychological stress and mental health disorders, including posttraumatic stress disorder (PTSD), are prevalent among young adults in the United States6 and may represent an important, yet largely unexplored, risk factor for early-onset stroke.

PTSD is a chronic stress condition that develops after exposure to a traumatic life event and is characterized by persistent alterations in mood, intrusive memories, avoidance behavior, and hyperarousal.

7 PTSD is more prevalent (10%–40%) among younger populations and those with exposure to military deployment, sexual assault, gun violence, and other forms of adversity8 and is hypothesized to influence the development and progression of cerebrovascular disease through multiple biological and behavioral pathways (eg, inflammation, smoking, and atherosclerosis).9 Although stress and trauma symptoms have been linked to stroke in older adults,10–13 it is unclear whether, and to what extent, PTSD increases the risk of early incident stroke in young adults who may have a different stroke risk factor profile.14

To address this gap in knowledge, we prospectively assessed the association between PTSD and incident TIA and ischemic stroke during a 13-year period in a national sample of 1.

1 million young and middle-aged US service members who deployed in support of recent conflicts in Iraq and Afghanistan (eg, Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn).

Additionally, because sex is increasingly recognized as an important modulator of stroke risk and outcomes,15 we examined sex as a modifier of the association between PTSD and incident TIA and ischemic stroke.

Data Sources and Study Population

Although data sharing agreements prohibit us from making the dataset publicly available, access may be granted from the corresponding author on reasonable request.

The study cohort was derived from a roster of young Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans maintained by the Veterans Health Administration (VHA) and the Defense Manpower Tracking System.

The roster contains sociodemographic data for all men and women discharged from the US military since October 1, 2001 (n=1 063 973).

Data from the roster were merged with VA (1) inpatient, outpatient, and pharmacy data from the Corporate Data Warehouse and (2) medical claims data for non-VA care from the VA Fee Basis Inpatient and Outpatient database.

Baseline was defined as the date of a patient’s first VHA clinical encounter on or after October 1, 2001. Clinical diagnoses were only considered present if the International Classification of Diseases, Ninth Revision (ICD-9) code for that specific condition was recorded during hospitalization or in at least 2 outpatient encounters. This methodology has been used extensively in research conducted with VHA and Medicare claims data, and has been shown to enhance diagnostic accuracy in these data sources.16,17

A flowchart of the study cohort selection is provided as Figure 1.

We restricted our analyses to include only patients who were free of ischemic stroke and TIA at baseline and who had at least 1 inpatient or 2 outpatient medical visits at a VHA facility between October 1, 2001, and November 1, 2014 (the most recent data available).

Of the 1 063 973 patients in the source population, 76 118 (7.15%) were excluded because of prior diagnoses of stroke or TIA, and insufficient medical visits during follow-up, leaving a final sample of 987 855 patients.

There were no differences between patients included versus excluded age, sex, or race/ethnicity. The study protocol and waiver of informed consent were approved by the Institutional Review Boards at Yale School of Medicine and VA Connecticut Healthcare System.

Figure 1. Study flowchart. OEF indicates Operation Enduring Freedom; OIF, Operation Iraqi Freedom; OND, Operation New Dawn; PTSD, posttraumatic stress disorder; TIA, transient ischemic attack; and VHA, Veterans Health Administration.

Ascertainment of Stroke Cases and PTSD Exposure

The outcome of interest was the first occurrence of stroke, defined as a new ICD-9 code for TIA (435.0, 435.1, 435.3, 435.8, and 435.9) and ischemic stroke (433.X1, 434.00, 434.

X1, and 436) during the period of observation. Prior validation work has demonstrated high agreement between these codes and formal chart adjudication (positive predictive value, 81.6%–90.0%; κ=0.86).

16–18 The earliest stroke event was considered the index event.

The primary exposure was a diagnosis of PTSD (ICD-9, 309.81) before the index stroke.

PTSD diagnoses were identified using a validated algorithm that has been used in numerous VHA studies19–21 and has demonstrated good concordance with PTSD diagnoses obtained from both diagnostic interview (the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV; 79.4%) and a widely used screening instrument (PTSD checklist; 82%).22

Covariates

Covariates were selected prior work23,24 and included demographic data (age, sex, race/ethnicity, and marital status), body mass index, and smoking status. Body mass index was dichotomized using a cut point of ≥30 kg/m2 (obese versus nonobese).

Comorbidities were ascertained by validated ICD-9–based algorithms for diagnoses of hypertension, lipid disorders, vascular disease, coronary artery disease, myocardial infarction, chronic obstructive pulmonary disease, obstructive sleep apnea, congestive heart failure, and alcohol and drug abuse.

We also adjusted for major depressive disorder and generalized anxiety disorder, as these conditions have been associated with both PTSD and stroke in previous studies.

12,25 Prescription data for antihypertensive medications (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, calcium channel blockers, and diuretics) and antidepressant medications (selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors) were obtained from VA pharmacy records.

Statistical Analysis

Analyses were conducted using SAS, version 9.4 (SAS Institute, Inc, Cary, NC), and statistical significance was determined by a 2-sided P of

Source: https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.026854

PTSD Linked to Stroke Risk in Younger Adults

Why PTSD Increases Your Risk of Having a Stroke

By Robert Preidt
HealthDay Reporter

THURSDAY, Oct. 17, 2019 (HealthDay News) — Young and middle-aged adults with post-traumatic stress disorder (PTSD) have an increased risk of stroke, new research suggests.

For the study, researchers analyzed medical data from more than 1 million veterans who served in Iraq and Afghanistan. They ranged in age from 18 to 60 years and two-thirds were white.

Of those, 29% had been diagnosed with PTSD. None had previously suffered a stroke or mini-stroke (also known as a transient ischemic attack, or “TIA”).

During 13 years of follow-up, 766 vets had a TIA and 1,877 had an ischemic stroke, which is caused by blocked blood flow to the brain.

Veterans with PTSD were 62% more ly to have a stroke, raising the risk more than known risk factors such as obesity and smoking. They were also twice as ly to have a TIA, increasing the risk more than diabetes and sleep apnea.

Even after accounting for known stroke risk factors, mental health disorders (such as depression and anxiety) and drug and alcohol abuse, the investigators found that veterans with PTSD were still 61% more ly to have a TIA and 36% more ly to have a stroke than vets without PTSD.

The link between PTSD and stroke was stronger in men than in women. In addition, vets with PTSD were more ly to have unhealthy habits — such as smoking and inactivity — that increase stroke risk, according to the study published Oct. 17 in the journal Stroke.

Previous studies have shown that PTSD increases heart disease and stroke risk for older adults, but the researchers said this is the first study to identify a link between PTSD and the risk of TIA and stroke in young and middle-aged adults. These groups have had a large increase in strokes over the past decade, the study authors noted.

“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 lead author Lindsey Rosman. She's an assistant professor in the cardiology division 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,” she explained in a journal news release.

PTSD affects about 30% of U.S. veterans. While this study focused on veterans, about 8 million U.S. adults have PTSD, which can develop when someone sees or experiences a traumatic event, such as sexual assault, gun violence, military combat or a natural disaster.

“PTSD is not just a veteran issue, it's a serious public health problem,” Rosman said.

Clinicians should be aware that mental health conditions PTSD are increasingly common among young people and may affect their risk of stroke, she added.

“Our findings raise important questions about whether early recognition and successful treatment of PTSD can prevent or decrease the lihood of developing stroke in those exposed to violence, trauma and severe adversity,” Rosman said.

SOURCE:Stroke, news release, Oct. 17, 2019 Copyright © 2013-2018 HealthDay. All rights reserved.

Source: https://www.webmd.com/depression/news/20191017/ptsd-linked-to-increased-risk-of-stroke-in-younger-adults

PTSD tied to higher, earlier stroke risk

Why PTSD Increases Your Risk of Having a Stroke

(Reuters Health) – Young adults who develop PTSD may be more ly to have a stroke by the time they are middle aged, a study of U.S. veterans suggests.

Researchers followed almost one million young and middle-aged veterans of the conflicts in Iraq and Afghanistan for more than a decade, starting when they were 30 years old, on average, and had no history of stroke. Overall, 29% had been diagnosed with PTSD.

During the study, 766 people had a transient ischemic attack, or brief “mini-stroke,” and another 1,877 people had a stroke.

Veterans with PTSD were 61% more ly than others to have a mini-stroke and 36% more ly to have a stroke, the study found.

“This trend is very concerning given the devastating impact stroke has 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 study leader Lindsey Rosman of the University of North Carolina School of Medicine in Chapel Hill.

“Because PTSD is a potentially treatable psychological condition, understanding the relationship between the two conditions may have important implications for improving stroke prevention and treatment in young and middle-aged adults,” Rosman said by email.

While PTSD has been shown to increase the risk of heart disease and stroke in older adults, this is the first study to show a link between trauma-induced stress disorders and the risk of stroke and mini-strokes in young and middle-aged adults, researchers note in the journal Stroke.

Most strokes occur when a clot blocks an artery carrying blood to the brain, known as an ischemic stroke. About 10% to 14% of ischemic strokes occur in adults ages 18 to 45, the study team notes.

Most of the veterans in the current study were men, and the majority were white.

There was a stronger link between PTSD and stroke in men than in women.

Even after accounting for behaviors that can raise stroke risk, smoking, getting little exercise and substance abuse, researchers still found an increased stroke risk associated with PTSD.

While the study focused on PTSD among military veterans, it’s possible that people with PTSD from other experiences natural disasters, gun violence or sexual assault might also have an increased stroke risk, the study authors conclude.

“We don’t fully understand how PTSD in young adults increases their risk of developing stroke at an early age, but multiple biological and behavioral pathways are ly involved,” Rosman said.

For example, prolonged exposure to intense psychological stress may lead to chronic inflammation that eventually contributes to stroke. Stress is also associated with unhealthy lifestyle behaviors such as smoking, physical inactivity, poor diet and substance abuse, which may increase risk for early stroke.

With PTSD, people may develop long-lasting symptoms of anxiety, avoidance, hypervigilance, anger, irritability, flashbacks and nightmares. This can happen just as easily for non-combat traumas and may lead to unhealthy behaviors that raise the risk of stroke among civilians, Rosman said.

The study focused on younger veterans, and results might be different for older veterans or other older adults with more traditional risk factors for stroke heart rhythm disorders or heart failure, the research team notes.

“The causes, characteristics and consequences of stroke for young patients will ly differ from those for the ‘typical’ stroke patient who is much older and more ly to have other medical conditions,” Rosman said. “We can’t just apply a one-size fits all strategy to address this problem.”

SOURCE: bit.ly/31HUjdO Stroke, online October 17, 2019.

Our Standards:The Thomson Reuters Trust Principles.

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Source: https://www.reuters.com/article/us-health-ptsd-stroke/ptsd-tied-to-higher-earlier-stroke-risk-idUSKBN1X22J0

Post-Stroke Posttraumatic Stress Disorder: A Review

Why PTSD Increases Your Risk of Having a Stroke

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Research Shows Veterans With PTSD Have Increased lihood of Stroke as Young Adults

Why PTSD Increases Your Risk of Having a Stroke

Although stroke is often considered an older person’s disease, about 10 to 14 percent of strokes occur among adults ages 18 to 45, according to previous research. And that trend is increasing. Why? New research shows that stress might be a contributing factor.

A study of veterans with post-traumatic stress disorder (PTSD) — published in the November 2019 issue of the journal Stroke — found that young and middle-aged veterans with the condition had a 61 percent greater risk of transient ischemic attack (sometimes called a “ministroke”) and a 36 percent greater risk of a regular ischemic stroke than those without PTSD.

“Given the evidence from studies of older adults and their elevated exposure to stressful life events, we anticipated that PTSD may be a potentially important risk factor for stroke in young people,” says lead study author, Lindsey Rosman, PhD, assistant professor of medicine in the division of cardiology at the University of North Carolina (UNC) School of Medicine in Chapel Hill. “But we were surprised by the strength of the association compared with other well-known risk factors for stroke.”

Dr. Rosman and her team observed that PTSD was a stronger predictor of transient ischemic attack (TIA) than diabetes, sleep apnea, and COPD. PTSD was also more strongly linked to early-onset ischemic stroke compared with lifestyle factors such as smoking, obesity, and drug use.

PTSD, however, was a weaker predictor of ischemic stroke than atrial fibrillation, vascular disease, and several other clinical comorbidities.

Study authors based results on medical data from 1.1 million veterans who served in Iraq and Afghanistan. Subjects were about 88 percent male, primarily white, with an average age of 30 at the start of the investigation. None had experienced either an ischemic stroke or a ministroke. Over a 13-year period, however, 766 suffered a ministroke and 1,877 had an ischemic stroke.

Differences Between Men and Women

While Rosman and her colleagues did find not any sex differences in PTSD-related risk for TIA, they did discover men with PTSD have a higher risk of having an ischemic stroke event than women. They speculate that the risk difference could be driven by age-related differences in stroke risk.

“Since men are more ly to develop stroke at younger ages and the mean age of our sample was relatively young, we may have just captured more strokes in men than in women,” says Rosman. “It’s also possible that the effect of sex on PTSD and other risk markers for stroke changes over time as the population ages.”

RELATED: Women and PTSD, the Public Health Problem Nobody Talks About

Why Stress Raises Stroke Risk

Previous research has shown that stress is linked to stroke risk in older adults. It can lead to higher blood pressure and cholesterol levels, as well as increased smoking, overeating, and physical inactivity, according to the American Heart Association.

“Psychological stress may lead to the secretion of pro-inflammatory chemicals — cytokines — in the blood stream,” says Rohan Arora, MD, director of the stroke program at Long Island Jewish Forest Hills–Northwell Health in Queens, New York. “These chemicals may cause injury to the walls of the arteries, leading to clogged arteries.”

Indirectly, stress is associated with a greater lihood of smoking, physical inactivity, poor diet, and substance abuse, which may all increase risk for early stroke.

All Young Adults Face Consequences of Severe Stress

Rosman emphasizes that PTSD is not just a veteran issue but a serious public health problem. The patients followed in this study may not only have developed the condition from combat, but from exposure to other stressful or traumatic life events, such as a sexual assault, gun violence in their communities, or deadly and destructive natural disasters.

“The daily lifestyle of young people is also filled up with stress,” says Dr. Arora. “This affects young adults beyond the military — daily psychological stress is something that all young people should identify and treat.”

Increased awareness is the first step to improving matters among this population, according to study authors.

“From a public health perspective, there exists a great opportunity to improve stroke prevention in young adults through the development of targeted screening programs, tailored patient counseling on individual risks, and age-appropriate interventions,” says Rosman.

Evidence-based treatments include talk therapy, such as cognitive-processing therapy and prolonged exposure therapy, and medication  selective serotonin reuptake inhibitors (SSRIs).

“Patients who are having difficulty adjusting and coping with a traumatic event should seek care for their symptoms,” says Rosman.

Arora adds that young adults need to address unhealthy behaviors that can be aggravated by stress.

“Cigarette smoking, physical inactivity, and increase in substance and alcohol abuse will all indirectly cause people to be more prone to stroke,” he says.

Because the study was limited by focusing strictly on a mostly male veteran population, scientists would to validate findings in a more diverse, nonveteran population and explore underlying mechanisms between stress and PTSD.

“Future studies will need to determine whether early identification of PTSD symptoms and treatment mitigates the risk of early stroke,” says Rosman. “If so, addressing mental health issues, including PTSD, may be an important part of a broader public health initiative to reduce the growing burden of stroke in young people.”

Source: https://www.everydayhealth.com/stroke/post-traumatic-stress-disorder-may-increase-likelihood-of-stroke-in-younger-adults/

Stroke Risk Increased For Younger Adults With PTSD, Study Finds

Why PTSD Increases Your Risk of Having a Stroke

Illustration of a cerebrovascular accident (CVA) caused by an occlusion (atheromatous plaque which … [+] diminishes or obstructs the arterial lumen) in the carotid. (Photo by: BSIP/Universal Images Group via Getty Images)

Universal Images Group via Getty Images

Young adults with posttraumatic stress disorder (PTSD) may be at increased risk for mini-stroke (transient ischemic attack,TIA) or a major stroke by middle age, new research published in the journal Stroke.  

The study found that having PTSD seemed to elevate the risk as much as other more well-known risk factors, such as smoking, obesity, high blood pressure, atrial fibrillation, and elevated cholesterol.

To conduct their study, the researchers looked data from more than 1 million veterans who served in Iraq and Afghanistan, ranging in age from 18-60. 2/3 of the study group were Caucasian.

Among this group, 29% had been diagnosed with PTSD. No persons had previously had a TIA or stroke.

Over a 13-year follow-up period, 766 veterans had a TIA and 1,877 had an ischemic stroke, the result of disruption of blood flow to the brain.

The study found that veterans with PTSD were 62% more ly to have a stroke, a much sharper increase than would have been expected from more well recognized risk factors such as elevated blood pressure, smoking, obesity, and high cholesterol.

The researchers found that veterans with PTSD were 61% more ly to have a TIA, and 36% more ly to have a stroke than veterans without PTSD, even after accounting for traditionally accepted stroke risks, along with depression, anxiety and substance abuse.

The study also found that the link with PTSD and stroke was more evident in men than compared with women. Veterans with PTSD were also more apt to have unhealthy lifestyle habits including a sedentary lifestyle, smoking, and an unhealthy diet along with obesity.

While previous research has demonstrated that PTSD can increase the risk for developing coronary artery disease, heart attack and stroke in older adults, the investigators explained that this is the first study to reveal a link between PTSD and the increased risk for TIA and stroke in young and middle-aged adults. Data indicates that young adults have seen a significant increase in incidence of strokes over the past 10 years.

“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, Ph.D.

, lead author of the study and Assistant Professor of Medicine in the Division of Cardiology at University of North Carolina School of Medicine in Chapel Hill in a press release.

“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.”

The role of PTSD leading to elevated levels of inflammation in the blood vessels triggering premature atherosclerosis is worthy of further investigation. But the contribution of lifestyle factors–-diet, smoking and substance abuse–triggered by PTSD needs to be considered as well.

We know that PTSD affects approximately 30% of U.S. veterans. While this study involved only veterans, it’s vital to realize that PTSD affects close to 8 million adults in the U.S.

PTSD can occur when someone witnesses or experiences a traumatic event such as sexual assault, gun violence or a mass shooting, military combat or even a natural disaster.

Physical symptoms of anxiety (elevated heart rate, chest pain, palpitations, sweating and tunnel vision) may develop along with feelings of anger, irritability, avoidance, hypervigilance, flashbacks as well as nightmares.

“PTSD is not just a veteran issue, it's a serious public health problem,” said Rosman.

“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,” she explained.

“Our findings raise important questions about whether early recognition and successful treatment of PTSD can prevent or decrease the lihood of developing stroke in those exposed to violence, trauma and severe adversity.”

While the research demonstrated a strong association between PTSD and premature TIA and stroke, it’s impossible to infer causality this study alone.

Further study limitations included the young age of the veterans–without traditional stroke risk factors such as atrial fibrillation or even congestive heart failure that would be more typical for older adults, making the results not applicable to the older persons and civilians.

“We need to improve stroke prevention in young adults by developing targeted screening programs and age-appropriate interventions. Addressing mental health issues including PTSD may be an important part of a broader public health initiative to reduce the growing burden of stroke in young people,” added Rosman.

Screening young adults for symptoms of PTSD by obtaining detailed mental health histories should be a consideration for improving overall stroke care. We need to look at the whole picture when this group presents with strokes and mini-strokes.

Source: https://www.forbes.com/sites/robertglatter/2019/10/18/stroke-risk-increased-for-younger-adults-with-ptsd-study-finds/