Post-Traumatic Stress Linked to Metabolic Syndrome

SAN DIEGO, Calif., Jan. 7 -- Post-traumatic stress disorder can be associated with metabolic syndrome, researchers here found.

Among male and female veterans, PTSD increased the risk of metabolic syndrome independent of depression, substance abuse, and other factors (P=0.005), Pia S. Heppner, Ph.D., of the University of California San Diego and VA Health Care System, and colleagues reported online in BMC Medicine.

In their cross-sectional study, the likelihood of meeting diagnostic criteria for metabolic syndrome rose with PTSD severity (P=0.03).

These preliminary findings likely represent generalized health risks from the chronic anxiety and stress that characterize PTSD, because metabolic syndrome predicts morbidity and mortality, Dr. Heppner's group said.

"Perhaps metabolic syndrome in itself is a useful clinical tool in quantifying the cardiovascular and metabolic impact of PTSD," they suggested.

In prior studies of work-related stress, researchers have shown lower heart rate variability, increased levels of inflammatory markers, and other effects linked to the metabolic syndrome and cardiovascular health.

To explore this link, the researchers analyzed clinical data from 253 male and female veterans who entered Gulf War Screening and PTSD Programs at the Cincinnati VA.

Among them, 55% had PTSD according to DSM-IV criteria of presence of intrusion, avoidance and hyperarousal scores, as well as a score of 65 or higher on the Clinician Administered PTSD Scale (CAPS).

Another 24% of participants met DSM-IV criteria but with a lower score on CAPS. Almost two-thirds met criteria for major depressive disorder.

Overall, 40% of the veterans met criteria for the metabolic syndrome -- elevated blood pressure, waist-to-hip ratio, and fasting concentrations of HDLs, triglycerides, and glucose -- as defined by the World Health Organization and National Cholesterol Education Program.

This rate, and the 43% rate among those with PTSD, was somewhat higher than the general population 20% to 31% prevalence found in the National Health and Nutrition Examination Survey (NHANES) studies, Dr. Heppner's group noted.

After adjustment for sociodemographic variables, depression, and use of alcohol and other substances, PTSD score on the CAPS was a significant predictor of metabolic syndrome (P=0.03). The risk rose one percentage point per point on the CAPS.

Among the individual components of the metabolic syndrome, only diastolic blood pressure was significantly different between those with PTSD and those without it, "suggesting the utility of considering these measures collectively as presence or absence of metabolic syndrome," Dr. Heppner and colleagues said.

While the study included relatively few women -- just 7.9% -- the researchers noted that gender was a significant predictor of lower metabolic syndrome risk (odds ratio 0.17, P=0.028).

Major depressive disorder was not a significant predictor of metabolic syndrome risk by itself.

The researchers cautioned that "in spite of the growing attention on the importance and surveillance of metabolic syndrome . . . there is still considerable controversy regarding its definition and utility."

They also acknowledged that because of the cross-sectional design, the study could not establish causal links between the anxiety disorder and metabolic effects and that the findings might have been limited by the low diversity of the sample. Thu Jan 8, 2009 7:36 pm

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