بررسی فاکتورهای خطر قلبی عروقی و سندروم متابولیک در جانبازان جنگ با بیماری استرس مزمن ناشی از تروما و گروه شاهد آن‌ها در استان زنجان سال 91-1390

Background and Objective: It seems that war veterans are at increased risk of cardiovascular diseases due to their existing disabilities and special mental and psychological conditions. This study was performed to evaluate the risk of cardiovascular disease and the prevalence of metabolic syndrome among Iran-Iraq war veterans living in Zanjan in 2011. Materials and Methods: 360 men including 120 war veterans with post-traumatic stress disorder (PTSD), 120 war veterans with major depression and 120 normal healthy men as the control group comprised this descriptive study and data was collected concerning their past medical history along with a comprehensive physical examination. The participants’ anthropometric index was measured by standard methods. Serum glucose, triglycerides, total cholesterol, HDL-cholesterol, insulin and liver enzymes were measured for all the participants after at least 12 hours of fasting and ten-year risk estimation for cardiovascular events was performed via Framingham scoring system. Finally, the prevalence of cardiovascular risk factors and metabolic syndrome was compared among the groups. Results: The prevalence of metabolic syndrome in war veterans with and without PTSD was 29.2% and 27.5%, respectively, which was higher than the control group (18.3%). 18.4% of war veterans with PTSD was estimated to be of high risk for cardiovascular events in upcoming ten years which means higher than the other two study groups namely in war veterans without PTSD and normal subjects, respectively. The most common risk factor in veterans with PTSD was overweight and obesity as found in 58% of them. Conclusions: Prevalence of metabolic syndrome in veterans with PTSD is higher than general population and they are at higher risk for cardiovascular events. Special attention to improve lifestyle and educational programs for prevention of cardiovascular disease is suggested. References 1- Carrion VG, Weems CF, Ray R, Reiss AL. Toward an empirical definition of pediatric ptsd: the phenomenology of ptsd symptoms in youth. J Am Acad Child Adolesc Psychiatry. 2002 41: 166-73. 2- Yehuda R. Post traumatic stress disorder: N Engl J Med. 2002 346: 108-14. 3- Heppner PS, Crawford EF, Haji U, et al. The association of posttraumatic stress disorder and metabolic syndrome: a study of increased health risk in veterans. BMC Med. 2009 7: 1 4- Shakeri J, Sadeghi Kh, Sadra K, Modaresi S. Examine the role of stressful life events and coping strategies in recurrent PTSD symptoms in a sample of war veterans. International congress of military medicine. Kermanshah, Iran. 5- Friedman MJ, Keane TM, Resick PA. Handbook of PTSD. Science and Pratice. New York: The Guilford Press 2007: 5-10. 6- McFarlane AC. The long-term costs of traumatic stress: intertwined physical and psychological consequences. World Psychiatry. 2010 9: 3-10. 7- Boscarino JA, Chang J. Electrocardiogram abnormalities among men with stress-related psychiatric disorders: implications for coronary heart disease and clinical research. Ann Behav Med. 1999 21: 227-34. 8- Gerardi RJ, Keane TM, Cahoon BJ, Klauminzer GW. An in vivo assessment of physiological arousal in posttraumatic stress disorder. J Abnom Psychol. 1994 103: 825-7. 9- Keane TM, Kolb LC, Kaloupek DG, et al. Utility of psychophysiological measurement in the diagnosis of posttraumatic stress disorder: results from a department of veterans affairs cooperative study. J Consult Clin Psychol. 1998 66: 914-23. 10- Bedi US, Arora R. Cardiovascular manifestations of posttraumatic stress disorder. J National Med Assoc. 2007 99: 642-9. 11- Kleim B, Wilhelm FH, Glucksman E, Ehlers A. Sex differences in heart rate responses to script-driven imagery soon after trauma and risk of posttraumatic stress disorder. Psychosom Med. 2010 72: 917-24. 12- Libby P, Bonow O, Mann L, Zipes P. Branvalds heart disease: diabetes mellitus, the metabolic syndrome, and atheroscelerotic vascular disease. 8th ed. 2008: 1093-1116. 13- Kubzansky L D, Koenen K C. Is posttraumatic stress disorder related to development of heart disease? An Update. Celin J Med. 2009 76. 14- Solter V, Thaller V, Karlovic D, et al. Elevated serum lipids in veterans with combat-related chronic posttraumatic stress disorder. Croat Med J. 2002 43: 685-9. 15- Kagan BL, Leskin G, Haas B, et al. Elevated lipid levels in Vietnam veterans with chronic posttraumatic stress disorder. Biol Psychiatry. 1999 45: 374-7. 16- Mason JW, Giller EL, Kosten TR, Harkness L. Elevation of urinary norepinephrine/cortisol ratio in posttraumatic stress disorder. J Nerv Mental Dis. 1988 176: 498-502. 17- Kibler JL, Joshi K, Ma M. Hypertension in relation to posttraumatic stress disorder and depression in the US national comorbidity survey. Behav Med. 2009 34: 125-32. 18- O’Toole BI, Catts SV. Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. J Psychosom Res. 2008 64: 33-40. 19- Sen Y, Kandemir N, Alikasifoglu A, Gonc N, Ozon A. Prevalence and risk factors of metabolic syndrome in obese children and adolescents: the role of the severity of obesity. Eur j pediator. 2008 167: 1183-9. 20- Vidovic A, Grubisic-llic M, Kozaric-Kovacic D, et al. Exaggerated platelet reactivity to physiological agonists in war veterans with posttraumatic stress disorder. Psychoneuroendocrinology. 2010 36: 161-72. 21- Schultz R. Cardiovascular disease and depression. Aust Fam Physician 2001. 30: 219-23 22- Lee H, Macfarlane D, Lam TH, Stewart S. Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review. Int J Behav Nutr and Phys Act. 2011 8: 115. 23- Sharifi F, mousavinasab SN, Saeini M, Dinmohammadi M. Prevalence of metabolic syndrome in an adult urban population of the west of iran. Exp Diabetes Res. 2009: 136501. 24- Tochigi M, Umekage T, Otani T, et al. Serum cholesterol, uric acid and cholinesterase in victims of the Tokyo subway sarin poisoning: a relation with post-traumatic stress disorder . Neurosci Res. 2002 44: 267-72. 25- Dobie DJ, Kivlahan DR, Maynard C, et al. Postraumatic stress disorder in female veterans. Association with self-reported health problems and functional impairment. Arch Intern Med. 2004 164: 394-400. 26- Buckley TC, Kaloupek DG. A meta-analytic examination of basal cardiovascular activity in posttraumatic stress disorder. Psychosom Med. 2001 63: 585-94. 27- Kang HK, Bullman TA, Taylor JW. Risk of selected cardiovascular diseases and posttraumatic stress disorder among former world war II prisoners of war. Ann Epidemiol. 2006 16: 381-6. 28- Schnurr PP, Green BL. Understanding relationships among trauma, post-traumatic stress disorder, and health outcomes. Adv Mind Body Med. 2004 20: 18-29. 29- Kubzansky LD, Koenen KC, Jones C, Eaton WW. A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women. Health Psychol. 2009 28: 125-30. 30- Dirkzwager AJE, van der Velden PG, Grievink L, Yzermans CJ. Disaster-related posttraumatic stress disorder and physical health. Psychosomatic Med. 2007 69: 435-40. 31- Spitzer C, Barnow S, Volzke H, et al. Trauma, posttraumatic stress disorder, and physical illness: findings from the general population. Psychosom Med. 2009 71: 1012-7. 32- Johnson AM, Rose KM, Elder GH, Jr, et al. Military combat and burden of subclinical atherosclerosis in middle aged men: the ARIC study. Prev Med. 2010 50: 277-81.