Abstract 10591: Post-traumatic Stress Disorder, Metabolic Syndrome and Cardiovascular Mortality;the Role of Selective Serotonin Reuptake Inhibitor

Abstract

Background: Lifetime prevalence of combat post-traumatic stress disorder (PTSD) is 5% to 20% in the United States. We recently reported a significant relation of PTSD with subclinical and cardiovascular (CV) mortality. Multiple studies have shown the beneficial effects of selective serotonin reuptake inhibitor (SSRI) on reducing PTSD symptoms. This study investigates the effect of SSRI on metabolic syndrome (Met-Syn) and cardiovascular (CV) mortality in PTSD subjects without known coronary artery disease and diabetes mellitus.

Method: This study is inclusive of 1142 PTSD subjects (mean age: 57±14 years, 89% male). Subjects were followed for the median of 5-years. Veterans’ medical-diagnoses, pharmacotherapies, laboratories and psychological health status (PTSD vs. non-PTSD) were evaluated using VA electronic-medical-records. Met-Syn, based on the NCEP ATP III definition, was assessed. Survival regression analyses were employed to assess the effect of SSRI on Met-Syn and CV mortality in PTSD subjects.

Results: The incidence of Met-Syn was 53.4%. Receiving SSRI was significantly less in Met-Syn as compared to those without Met-Syn (31.9% vs. 44.7%, p=0.001). After adjustment for age, gender and risk factors, the relative risk of Met-Syn in PTSD was 0.29 (95%CI 0.26 - 0.31, p=0.0001) with SSRI as compared to those without SSRI. At 5-year follow-up, the CV mortality rate was 17.7%; which was significantly higher in PTSD with Met-Syn as compared to those without (21% vs. 14%, p=0.001); which the risk of CV mortality was 68% higher with Met-Syn (hazard ratio(HR): 1.68, 95%CI 1.61- 1.75, p=0.001). Multivariable-survival-regression analyses revealed a significant indirect association between SSRI and Met-Syn with increased risk of CV-morality (p<0.05). The risk of CV mortality was significantly less in PTSD subjects who receiving SSRI, especially in those without Met-Syn (p<0.05). After adjustment for risk-factors, HR of CV-mortality was 0.62 and 0.36 in PTSD subjects receiving SSRI with and without Met-Syn (p<0.05).

Conclusion: SSRI therapy is associated with favorable cardiometabolic protection effects as well as reduction of mortality in subjects with PTSD, after adjustment for age, gender and conventional risk factors.