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Lifetime Trauma Exposure and Prospective Cardiovascular Events and All-Cause Mortality: Findings From the Heart and Soul Study

Hendrickson, Carolyn M. MD, MPH, MA; Neylan, Thomas C. MD; Na, Beeya MPH; Regan, Mathilda MPH; Zhang, Qian MPH; Cohen, Beth E. MD, MAS

doi: 10.1097/PSY.0b013e3182a88846
Original Articles

Objective Little is known about the effect of cumulative psychological trauma on health outcomes in patients with cardiovascular disease. The objective of this study was to prospectively examine the association between lifetime trauma exposure and recurrent cardiovascular events or all-cause mortality in patients with existing cardiovascular disease.

Methods A total of 1021 men and women with cardiovascular disease were recruited in 2000 to 2002 and followed annually. Trauma history and psychiatric comorbidities were assessed at baseline using the Computerized Diagnostic Interview Schedule for DSM-IV. Health behaviors were assessed using standardized questionnaires. Outcome data were collected annually, and all medical records were reviewed by two independent, blinded physician adjudicators. We used Cox proportional hazards models to evaluate the association between lifetime trauma exposure and the composite outcome of cardiovascular events and all-cause mortality.

Results During an average of 7.5 years of follow-up, there were 503 cardiovascular events and deaths. Compared with the 251 participants in the lowest trauma exposure quartile, the 256 participants in the highest exposure quartile had a 38% greater risk of adverse outcomes (hazard ratio = 1.38, 95% confidence interval = 1.06–1.81), adjusted for age, sex, race, income, education, depression, posttraumatic stress disorder, generalized anxiety disorder, smoking, physical inactivity, and illicit drug abuse.

Conclusions Cumulative exposure to psychological trauma was associated with an increased risk of recurrent cardiovascular events and mortality, independent of psychiatric comorbidities and health behaviors. These data add to a growing literature showing enduring effects of repeated trauma exposure on health that are independent of trauma-related psychiatric disorders such as depression and posttraumatic stress disorder.

From the Departments of Medicine (C.M.H., B.E.C.) and Psychiatry (T.C.N.), University of California, San Francisco, California; and Mental Health Services (T.C.N.) and Section of General Internal Medicine (B.N., M.R., Q.Z., B.E.C.), Veterans Affairs Medical Center, San Francisco, California.

Address correspondence and reprint requests to Beth Cohen, MD, MAS, Department of Veterans Affairs Medical Center, General Internal Medicine (111A1), 4150 Clement Street, San Francisco, CA 94121. E-mail:

Received for publication May 1, 2012; revision received July 18, 2013.

Copyright © 2013 by American Psychosomatic Society
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