Relationship between Post-traumatic Stress Disorder and subsequent myocardial infarction: a systematic review and meta-analysis

Abstract

Background: Each year, nearly 790.000 new cases of myocardial infarction (MI) are recorded in the United States. Better knowledge of the modifiable risk factors for this cardiovascular disease remains a major public health issue. In this perspective, the aim of this systematic review and meta-analysis was to estimate the relationship between post-traumatic stress disorder (PTSD) and risk of subsequent myocardial infarction (MI).

Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines was performed by searching four bibliographic databases (PubMed/Medline, PsycINFO, Science Direct and Proquest Dissertations and Theses).

Results: A total of 14 articles were included. Nine of these included depression as a covariate. Among 13 studies (N = 848.903), the pooled HR for the magnitude of the relationship between PTSD and MI was 1.49 (95% CI 1.31-1.69) before adjustment for depression. The pooled HR estimate for the 9 depression-adjusted estimates (N = 814.441) was 1.32 (95% CI 1.12-1.56).

Limitations: These results should be considered with caution because there is high heterogeneity between studies and possible publication bias; thus, further research is required to support these results.

Conclusions: Further research is still needed to identify in more precise terms the mediating factors involved in the direct association between PTSD and the subsequent occurrence of ischemic heart disease.

Keywords: Acute coronary syndrome, Myocardial infarction; Meta-analysis; Post-traumatic stress disorder (PTSD); Psychological trauma.