Evidence map›Paper›PMID 23978403›Full record

ArticleBiological psychiatry2013

Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder.

Jesse H Turner, Thomas C Neylan, Nelson B Schiller, Yongmei Li, Beth E Cohen

Abstract read
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In one paragraph

Article in Biological psychiatry, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

43 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  8. Post-traumatic stress disorder (PTSD) as a systemic disorder: Pathways to cardiovascular disease.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Jesse H TurnerDepartment of Medicine, University of California, San Francisco.
Thomas C Neylan
Nelson B Schiller
Yongmei Li
Beth E Cohen

Funding

Psychological Stress and Risk of Cardiovascular DiseaseK23HL094765 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI COHEN, BETH · 2009 to 2013
$776k
NHLBI NIH HHS K23 HL094765NHLBI NIH HHS K23 HL 094765-0
6 · The paper itself

Abstract

backgroundPatients with posttraumatic stress disorder (PTSD) are at increased risk for cardiovascular disease (CVD), but few studies have included objective measures of CVD and how PTSD causes CVD remains unknown. We sought to determine the association between PTSD and objectively assessed CVD and examine potential underlying mechanisms.

methodsOutpatients from two Veterans Affairs Medical Centers were enrolled from 2008 to 2010. Posttraumatic stress disorder was identified using the Clinician Administered PTSD Scale, and standardized exercise treadmill tests were performed to detect myocardial ischemia.

resultsOf the 663 participants with complete data, ischemia was present in 17% of patients with PTSD versus 10% of patients without PTSD (p = .006). The association between PTSD and ischemia remained significant after adjusting for potential confounders (age, sex, prior CVD) and mediators (traditional cardiac risk factors, C-reactive protein, obesity, alcohol use, sleep quality, social support, and depression), adjusted odds ratio (OR) 2.42, 95% confidence interval (CI) 1.39 to 4.22, p = .002. Findings remained significant when those with prior CVD were excluded (fully adjusted OR 2.24, 95% CI 1.20-4.18, p = .01) and when continuous PTSD symptom score was used as the predictor (fully adjusted OR per 10-point change in Clinician Administered PTSD Scale score 1.12, 95% CI 1.03-1.22, p = .01).

conclusionsPosttraumatic stress disorder was associated with ischemic changes on exercise treadmill tests independent of traditional cardiac risk factors, C-reactive protein, and several health behaviors and psychosocial risk factors, suggesting additional mechanisms linking PTSD and ischemia should be explored. The association of PTSD and ischemia among patients without known CVD highlights an opportunity for early interventions to prevent progression of cardiovascular disease.

Indexed as

Exercise TestFemaleHumansMaleMiddle AgedMyocardial IschemiaRisk FactorsStress Disorders, Post-TraumaticVeteransCardiovascular diseasecardiovascular stress testinginflammationlifestyle behaviorsmyocardial ischemiaposttraumatic stress disorder

Identifiers

PMID23978403
PMCPMC4005370

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.