Associations between stress disorders and cardiovascular disease events in the Danish population

BMJ Open. 2015 Dec 14;5(12):e009334. doi: 10.1136/bmjopen-2015-009334.


Objectives: Post-traumatic stress disorder (PTSD) is a well-documented risk factor for cardiovascular disease (CVD). However, it is unknown whether another common stress disorder-adjustment disorder--is also associated with an increased risk of CVD and whether gender modifies these associations. The aim of this study was to examine the overall and gender-stratified associations between PTSD and adjustment disorder and 4 CVD events.

Design: Prospective cohort study utilising Danish national registry data.

Setting: The general population of Denmark.

Participants: PTSD (n=4724) and adjustment disorder (n=64,855) cohorts compared with the general population of Denmark from 1995 to 2011.

Primary outcome measures: CVD events including myocardial infarction (MI), stroke, ischaemic stroke and venous thromboembolism (VTE). Standardised incidence rates and 95% CIs were calculated.

Results: Associations were found between PTSD and all 4 CVD events ranging from 1.5 (95% CI 1.1 to 1.9) for MI to 2.1 (95% CI 1.7 to 2.7) for VTE. Associations that were similar in magnitude were also found for adjustment disorder and all 4 CVD events: 1.5 (95% CI 1.4 to 1.6) for MI to 1.9 (95% CI 1.8 to 2.0) for VTE. No gender differences were noted.

Conclusions: By expanding beyond PTSD and examining a second stress disorder-adjustment disorder-this study provides evidence that stress-related psychopathology is associated with CVD events. Further, limited evidence of gender differences in associations for either of the stress disorders and CVD was found.


Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjustment Disorders / complications*
  • Adolescent
  • Adult
  • Aged
  • Denmark
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology*
  • Myocardial Infarction / psychology
  • Prospective Studies
  • Risk Factors
  • Stress Disorders, Post-Traumatic / complications*
  • Stroke / etiology*
  • Stroke / psychology
  • Surveys and Questionnaires
  • Venous Thromboembolism / etiology*
  • Venous Thromboembolism / psychology
  • Young Adult