By Amanda MacMillan
WEDNESDAY, June 20, 2012 (Health.com) — When people think of post-traumatic stress disorder (PTSD), they're apt to picture combat veterans or the victims of violence and sexual assault. But new research suggests post-traumatic stress is also common following another kind of harrowing experience: heart attacks.
As many as 1 in 8 people who survive a heart attack will go on to develop symptoms of PTSD, a new analysis has found. And to make matters worse, PTSD symptoms appear to increase the risk of having a second heart attack or dying prematurely.
A heart attack, in which blood flow to the heart is suddenly interrupted, is a common—and sometimes terrifying—experience, says Donald Edmondson, PhD, the lead author of the analysis and an assistant professor of behavioral medicine at Columbia University Medical Center, in New York City.
"About 1.4 million people [in the United States] have heart attacks every year; that's as many people as are in our entire active military," Edmondson says. "That feeling that your life is in danger—the loss of control when your body turns on you—is something that these people have a hard time forgetting."
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Previous research has found that heart attacks can contribute to depression, and a number of small studies have suggested a similar link to PTSD, a type of anxiety disorder. To assess just how common the disorder is in this population, Edmonson and his colleagues pooled and re-analyzed the results of 24 studies comprising 2,384 heart attack survivors from around the world.
Overall, 12% of study participants developed significant PTSD symptoms after having a heart attack, and 4% met the official criteria for a PTSD diagnosis. Although the methods varied from study to study, researchers generally focused on classic symptoms of the disorder, including frequent nightmares or flashbacks, intrusive thoughts, and elevated blood pressure or heart rate.
The findings, which appear this week in the journal PLoS ONE, are important for doctors and especially cardiologists, most of whom aren't trained to look for signs of anxiety in heart patients, says Ramin Ebrahimi, MD, an interventional cardiologist and clinical professor of medicine at the University of California, Los Angeles.
"It has become hard for physicians to have a holistic approach and to consider the whole picture," says Ebrahimi, who was not involved in the new analysis. "As a cardiologist, my main focus is opening the artery and making sure the medication is appropriate. Most doctors aren't thinking about whether the person is scared or traumatized at that point."
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Traumatization may influence a patient's prognosis, however. Three of the studies included in the analysis looked at the relationship between post-traumatic stress and subsequent hospitalizations in the years following a heart attack. Taken together, the studies suggest that heart attack survivors with PTSD symptoms are twice as likely as those without them to die or experience another heart attack or heart-related complication within three years.
The physiological changes associated with PTSD symptoms, such as elevated blood pressure, likely play a role in these patients' increased risk of heart attack, Edmonson says. And, as with depression, the disorder may cause patients to neglect their own care.
A study that follows a large group of heart attack survivors over time will be needed to confirm these theories. In the meantime, Edmonson says, the new findings should encourage doctors and heart patients to be aware of PTSD symptoms and seek out talk therapy or medication if needed.
"Unless you know that PTSD is a possibility, it's hard to say to your doctor, 'I'm thinking about my heart attack a lot more than I maybe should be, and it's making me anxious,'" he says. "Patients should know that 1 in 8 people are going to develop symptoms like these, and that there are good treatments out there for them."
PTSD is not "a disorder of veterans," Ebrahimi says. "It is a disorder that anybody can get after being exposed to a traumatic situation. Even if it's something that might not seem traumatic to you or me—having a gun pointed at you, almost being in an accident, surviving a heart attack—to that person, it can cause lasting symptoms."