Post-Traumatic Stress Disorder (PTSD) and cardiovascular diseases: a systematic review and meta-analysis
O. A. S. Al Nakhebi, V. R. EnatescuIntroduction
Post-traumatic stress disorder ( PTSD ) is a psychiatric condition characterized by intrusive memories, avoidance, negative mood alterations, and hyperarousal following trauma. Beyond its psychological burden, PTSD exerts multisystemic effects, including autonomic dysregulation, hypothalamic–pituitary–adrenal axis imbalance, inflammation, and health-risk behaviors, which increase cardiovascular disease ( CVD ) risk. Conversely , acute cardiac events can themselves precipitate PTSD , suggesting a bidirectional relationship.
Objectives
This meta-analysis examined: (1) the risk of incident CVD among individuals with PTSD , and (2) the prevalence of PTSD in patients with CVD
Methods
Following PRISMA guidelines, PubMed, Scopus, and Web of Science were searched up to May 2025. Eligible studies included observational or interventional human research reporting CVD incidence in PTSD or PTSD prevalence following CVD . Effect sizes were pooled using random-effects models. Heterogeneity was assessed with Q, I², and τ². Publication bias was evaluated with funnel plots and Egger’s test.
Results
Twenty-nine studies (
n ≈ 2.7 million
) met inclusion. Eighteen assessed
CVD
risk in
PTSD
populations (n ≈ 2.6 million). Pooled analysis showed
PTSD
increased
CVD
risk by 75% (log RR = 0.56, 95% CI = 0.42–0.69; p < 0.0001). Eleven studies (n ≈ 148,000) reported
PTSD
prevalence following
CVD
, with pooled estimates indicating 25.3% (95% CI = 0.19–0.31) of cardiac patients met diagnostic criteria or exhibited clinically significant
PTSD
symptoms. Both directions showed substantial heterogeneity but consistent effects across study designs and populations.
Image 1: Long description.