To examine the relationship between PTSD/TBI and Ischemic Stroke and Myocardial Infarction in a large patient population.

This was a retrospective study utilizing national data from Veterans Affairs VINCI database that included veterans who received care during the period of December 1998 to May 2014. Propensity score matching was used to obtain matched pairs of (1) Non-PTSD/TBI vs. PTSD  (2) Non-PTSD/TBI vs. TBI. Confounding variables used for matching were patients demographics and comorbidities. Cox proportional hazard regression analysis was conducted on matched pairs to determine the relationship between PTSD, TBI and incidence of myocardial infarction and stroke. KM curves were plotted to compare the time to development of incident myocardial infarction among the groups.

The result of our analyses showed a higher incidence of ischemic stroke in all subgroups compared to the control group: PTSD-only (836.4 vs 544.9 per 1000 person years), TBI-only (1855.8 vs 841.6 per 1000 person years) and PTSD+TBI (1095.6 vs 530.0 per 1000 person years), respectively. The risk of ischemic stroke was high among veterans with PTSD (HR 1.40 (95%CI, 1.38-1.42)) and PTSD+TBI (HR 1.85 (1.79-1.92)); however, it was highest in veterans with TBI-only (HR 3.17 (3.09-3.26)).

Similarly, the risk of new-onset MI was significantly higher for patients with PTSD/TBI when compared with their counterparts without PTSD/TBI. Risk of MI with TBI  (HR=2.687, CI 2.546-2.835, P<0.0001), was higher than with PTSD (HR=1.618, CI 1.574-1.662, P<0.0001).

There is a significant increase in the incidence of MI in veterans with a diagnosis of PTSD or TBI. Further studies are needed to risk stratify and intervene to help reduce the incidence of stroke and MI in this population.