Posttraumatic Stress Disorder and Cardiovascular Disease: State of the Science, Knowledge Gaps, and Research Opportunities | Psychiatry and Behavioral Health | JAMA Cardiology

<!DOCTYPE html> <html id="doc" lang="en" class="page-abstract"> <head id="Head1">  <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <script> var SCM = SCM || {}; if (SCM.AMA && SCM.AMA.DataLayerAsync) { SCM.AMA.DataLayerAsync.push("arrSisAffinity", "", "array"); SCM.AMA.DataLayerAsync.push("SubStatus", "no", "string"); } var googletag = window.googletag || {}; googletag.cmd = googletag.cmd || []; if (typeof Storage !== "undefined") { var targetingParamStr = localStorage.getItem("bcDFPTargetingParams"); if (targetingParamStr) { var targetingParameters = JSON.parse(targetingParamStr); // set page-level targeting parameters jQuery.each(targetingParameters, function (index, param) { googletag.cmd.push(function () { window.googletag.pubads().setTargeting(param.key, param.value); }); }); } } if (!googletag.pubads) { (function () { var gads = document.createElement('script'); var useSSL = 'https:' == document.location.protocol; gads.src = (useSSL ? 'https:' : 'http:') + '//securepubads.g.doubleclick.net/tag/js/gpt.js'; gads.setAttribute("async", ""); gads.setAttribute("defer", ""); var node = document.getElementsByTagName('script')[0]; node.parentNode.insertBefore(gads, node); })(); var App = App || {}; App.Ads = App.Ads || {}; App.Ads.adPath = App.Ads.adPath || '/6479/' + 'ama.jamacardiology'; App.Ads.Mappings = App.Ads.Mappings || {}; App.Ads.slots = App.Ads.slots || []; App.Ads.fromGoogle = !('yes' === 'yes'); App.isCollection = App.isCollection || !!document.getElementsByClassName('pg_collection').length; googletag.cmd.push(function () { googletag.pubads() .setTargeting('environment', ['newjama']) .setTargeting('site', ['ama.jamacardiology']) .setTargeting('sect', ['abstract']) .setTargeting('sub', ['no']) .setTargeting('device', ['Mozilla%2F4.0%20%28compatible%3B%20MSIE%207.0%3B%20Windows%20NT%206.0%3B%20SLCC1%3B%20.NET%20CLR%202.0.50727%3B%20.NET%20CLR%203.0.04506%3B%20.NET%20CLR%203.5.21022%3B%20.NET%20CLR%201.0.3705%3B%20.NET%20CLR%201.1.4322%29']) .setTargeting('usaphys', ['no']) .setTargeting('memberstat', ['no']) .setTargeting('pracset', ['']) .setTargeting('specialty', ['other']) .setTargeting('occupation', ['']) .setTargeting('useraffinity', ['']) .setTargeting('direct', ['yes']) .setTargeting('bot', ['']) .setTargeting('datacenter', ['no']) .setTargeting('selfMPA', ['']) .setTargeting('selfSpecialty', ['']); if (App.isCollection) { googletag.pubads().setTargeting('collection', ['']); } var testParam = getQueryVariable('test'); if (testParam) { googletag.pubads().setTargeting('test', [testParam]); } function getQueryVariable(variable) { var query = window.location.search.substring(1); var vars = query.split('&'); for (var i = 0; i < vars.length; i++) { var pair = vars[i].split('='); if (decodeURIComponent(pair[0]) == variable) { return decodeURIComponent(pair[1]); } } } googletag.pubads().disableInitialLoad(); googletag.enableServices(); }); } </script> <meta name="viewport" content="width=device-width, initial-scale=1" /><meta name="format-detection" content="telephone=no" /><link rel="shortcut icon" href="//cdn.jamanetwork.com/UI/app/img/favicons/cardiology/favicon.ico"> <link rel="icon" type="image/png" href="//cdn.jamanetwork.com/UI/app/img/favicons/cardiology/favicon-192x192.png" sizes="192x192"> <link rel="apple-touch-icon" sizes="180x180" href="//cdn.jamanetwork.com/UI/app/img/favicons/cardiology/apple-touch-icon-180x180.png"> <meta http-equiv="X-UA-Compatible" content="IE=Edge" /> <link rel="stylesheet" href="//cdn.jamanetwork.com/UI/app/dist/app.min.css?v=638677764476993385"> <link href="//cdn.jsdelivr.net/chartist.js/latest/chartist.min.css" type="text/css" rel="stylesheet" /> <meta property="og:title" content="Posttraumatic Stress Disorder and Cardiovascular Disease" /> <meta property="og:type" content="Article" /> <meta property="og:url" content="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781972" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/cardiology/938788/hsc210001f1_1633734735.93036.png?Expires=2147483647&Signature=3EKZeIarA2mJ0zVj2SnZ-KAizbfzChPcLvNBlmsxEHCHARd4gBA8nwAzBP9LZ17Qjn1i2KhUhmMu-t65ccVUK5c8n7iLHQM~07Fux5rXjwpJmR0LMdpD59rKG6tXEPkvlF~1rSzW0eny4VCee2C0YDKrSfCYi5HG-POhPWymIN2SRDp8m3T8u28Da2SqOYrkgIxH1j5F86gMg5VOLIPTCQdTSwIMaG2edtjdP6G23fRyur31VBW9rKY2FB3OB7eg9lEGxYAPqikQsNf0PEV9GLpol9ypo8rqVIAPfNyN8DWBZZvgy0~EVau4XgRJJbhTTzcCVNX6I-dJAUdJGBnFSQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/cardiology/938788/hsc210001t1_1633734735.96033.png?Expires=2147483647&Signature=bvn9s2a8ALWvCtROLrERLUpr21Xjvb4eZ2~4aL5p6TFnJeWKpN2FHIVT5Shs8V1Nc61nzaFImCm1t3gB2OWXbBnZuDeZ7MCKzX~-vJlBF4a3Dqvvd23ly6b0i7NkkAj-4Jsyn65mciHkX4hAjREKUPAPtXX541j05xibk9exyA42aktnvskreurdVtMOte1tjWPgl91LNGldmhh~RmTxXNwz2dIhc~zM8ft3qizBzEeVduaFB9FqtlRPl6BKNM7KT7o7n~WazX1wGdqdoG8kfnQ~WpRthi5oHOmaerN~FHlpzQykcyazTwVugykCCr07zRGA0XuGIgnVBB4CeeDiVQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/cardiology/938788/hsc210001t2_1633734735.98038.png?Expires=2147483647&Signature=D6YyOWHNqMQWq3L8LGjSGOPgFFlEint4glV2Kkg9a-whnv4tV3O78KilMm7yc~7LRljOuZSZ-4cbmaHysVWbId9kzm8yokk-50CbiCN5DG-ji6UL~af6hIMS7ODEDpPUIkofVYVtTMJfOxhO-V1NFB88446xWRs-c8j5IHgEFhCqa~ZQf10ny5tCI0ibrYb3KLNBSTljQyaESqkGz5DtOox70oc2NjDIAe61ABBvR5scISo6rjdNGalxGP2ZcBd0XYrnjLUA2kaMtEgeLSZSLVZgMoA0ZJSu2DsR1eQk7q2QLc49QIvr1vd1Rc-BW~oRJj34a0kxL2UbAkivqCSbMA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:description" content="This study critically reviews the available evidence on the association of posttraumatic stress disorder with cardiovascular disease from population, basic, and genomic research as well as from clinical and translational research." /> <meta property="fb:pages" content="87087958340" /> <meta property="fb:pages" content="122228711814384" /> <meta property="fb:pages" content="1648414928738217" /> <meta property="fb:pages" content="117506346528" /> <meta property="fb:pages" content="97538728726" /> <meta property="fb:pages" content="114116793520" /> <meta property="fb:pages" content="100679858757" /> <meta property="fb:pages" content="759822190741773" /> <meta property="fb:pages" content="100265333750" /> <meta property="fb:pages" content="234770525256" /> <meta property="fb:pages" content="98784919862" /> <meta property="fb:pages" content="120829458202" /> <meta property="fb:pages" content="124842870398" /> <meta property="fb:pages" content="110245330325636" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:site" content="@JAMACardio" /> <meta name="twitter:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/cardiology/938788/hsc210001f1_1633734735.93036.png?Expires=2147483647&Signature=3EKZeIarA2mJ0zVj2SnZ-KAizbfzChPcLvNBlmsxEHCHARd4gBA8nwAzBP9LZ17Qjn1i2KhUhmMu-t65ccVUK5c8n7iLHQM~07Fux5rXjwpJmR0LMdpD59rKG6tXEPkvlF~1rSzW0eny4VCee2C0YDKrSfCYi5HG-POhPWymIN2SRDp8m3T8u28Da2SqOYrkgIxH1j5F86gMg5VOLIPTCQdTSwIMaG2edtjdP6G23fRyur31VBW9rKY2FB3OB7eg9lEGxYAPqikQsNf0PEV9GLpol9ypo8rqVIAPfNyN8DWBZZvgy0~EVau4XgRJJbhTTzcCVNX6I-dJAUdJGBnFSQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta name="citation_author" content="Christopher J. O’Donnell" /><meta name="citation_author_institution" content="Cardiology Section, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts" /><meta name="citation_author_institution" content="Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts" /><meta name="citation_author_institution" content="Department of Medicine, Harvard Medical School, Boston, Massachusetts" /><meta name="citation_author" content="Lisa Schwartz Longacre" /><meta name="citation_author_institution" content="National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland" /><meta name="citation_author" content="Beth E. Cohen" /><meta name="citation_author_institution" content="UCSF Department of Medicine, University of California, San Francisco" /><meta name="citation_author" content="Zahi A. Fayad" /><meta name="citation_author_institution" content="Biomedical Engineering and Medical Institute, Icahn Mount Sinai School of Medicine, New York, New York" /><meta name="citation_author_institution" content="Department of Cardiology, Icahn Mount Sinai School of Medicine, New York, New York" /><meta name="citation_author" content="Charles F. Gillespie" /><meta name="citation_author_institution" content="Department of Psychiatry, Emory University, Atlanta, Georgia" /><meta name="citation_author" content="Israel Liberzon" /><meta name="citation_author_institution" content="Department of Psychiatry, Texas A&M University, College Station" /><meta name="citation_author" content="Gita A. Pathak" /><meta name="citation_author_institution" content="Yale University School of Medicine, New Haven, Connecticut" /><meta name="citation_author_institution" content="VA Connecticut Healthcare System, West Haven" /><meta name="citation_author" content="Renato Polimanti" /><meta name="citation_author_institution" content="Yale University School of Medicine, New Haven, Connecticut" /><meta name="citation_author_institution" content="VA Connecticut Healthcare System, West Haven" /><meta name="citation_author" content="Victoria Risbrough" /><meta name="citation_author_institution" content="Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla" /><meta name="citation_author_institution" content="VA Center of Excellence for Stress and Mental Health, San Diego, California" /><meta name="citation_author" content="Robert J. Ursano" /><meta name="citation_author_institution" content="Department of Psychiatry, Uniformed Services University, Bethesda, Maryland" /><meta name="citation_author" content="Richard S. Vander Heide" /><meta name="citation_author_institution" content="Department of Pathology, Louisiana State University Health Science, New Orleans" /><meta name="citation_author" content="Clyde W. Yancy" /><meta name="citation_author_institution" content="Department of Cardiology, Northwestern Medicine, Chicago, Illinois" /><meta name="citation_author_institution" content="Deputy Editor, JAMA Cardiology" /><meta name="citation_author" content="Viola Vaccarino" /><meta name="citation_author_institution" content="Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia" /><meta name="citation_author" content="George Sopko" /><meta name="citation_author_institution" content="National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland" /><meta name="citation_author" content="Murray B. Stein" /><meta name="citation_author_institution" content="Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla" /><meta name="citation_author_institution" content="Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla" /><meta name="citation_author_institution" content="VA San Diego Healthcare System, San Diego, California" /><meta name="citation_title" content="Posttraumatic Stress Disorder and Cardiovascular Disease: State of the Science, Knowledge Gaps, and Research Opportunities" /><meta name="citation_firstpage" content="1207" /><meta name="citation_lastpage" content="1216" /><meta name="citation_doi" content="10.1001/jamacardio.2021.2530" /><meta name="citation_keyword" content="cardiovascular diseases" /><meta name="citation_keyword" content="post-traumatic stress disorder" /><meta name="citation_keyword" content="translational research" /><meta name="citation_keyword" content="heart disease risk factors" /><meta name="citation_keyword" content="genome" /><meta name="citation_abstract" content="<p>Posttraumatic stress disorder (PTSD) is characterized by a persistent maladaptive reaction after exposure to severe psychological trauma. Traumatic events that may precipitate PTSD include violent personal assaults, natural and human-made disasters, and exposure to military combat or warfare. There is a growing body of evidence for associations of PTSD with major risk factors for cardiovascular disease (CVD), such as hypertension and diabetes, as well as with major CVD outcomes, such as myocardial infarction and heart failure. However, it is unclear whether these associations are causal or confounded. Furthermore, the biological and behavioral mechanisms underlying these associations are poorly understood. Here, the available evidence on the association of PTSD with CVD from population, basic, and genomic research as well as from clinical and translational research are reviewed, seeking to identify major research gaps, barriers, and opportunities in knowledge acquisition and technology as well as research tools to support and accelerate critical research for near-term and longer-term translational research directions. Large-scale, well-designed prospective studies, capturing diverse and high-risk populations, are warranted that include uniform phenotyping of PTSD as well as broad assessment of biological and behavioral risk factors and CVD outcomes. Available evidence from functional brain imaging studies demonstrates that PTSD pathophysiology includes changes in specific anatomical brain regions and circuits, and studies of immune system function in individuals with PTSD suggest its association with enhanced immune inflammatory activity. However, establishment of animal models and human tissue biobanks is also warranted to elucidate the potential causal connection of PTSD-induced brain changes and/or inflammation with CVD pathophysiology. Emerging large-scale genome-wide association studies of PTSD will provide an opportunity to conduct mendelian randomization studies that test hypotheses regarding the presence, magnitude, and direction of causal associations between PTSD and CVD outcomes. By identifying research gaps in epidemiology and genomics, animal, and human translational research, opportunities to better justify and design future interventional trials are highlighted that may test whether treatment of PTSD or underlying neurobiological or immune dysregulation may improve or prevent CVD risk or outcomes.</p>" /><meta name="citation_journal_title" content="JAMA Cardiology" /><meta name="citation_journal_abbrev" content="JAMA Cardiol" /><meta name="citation_volume" content="6" /><meta name="citation_issue" content="10" /><meta name="citation_publication_date" content="2021/10/01" /><meta name="citation_issn" content="2380-6583" /><meta name="citation_publisher" content="American Medical Association" /><meta name="citation_reference" content="citation_title=Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association.; citation_author=Levine GN; citation_author=Cohen BE; citation_author=Commodore-Mensah Y; citation_journal_title=Circulation; citation_year=2021; citation_volume=143; citation_issue=10; citation_pages=e763-e783; " /><meta name="citation_reference" content="citation_title=Post-traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice.; citation_author=Koenen KC; citation_author=Sumner JA; citation_author=Gilsanz P; citation_journal_title=Psychol Med; citation_year=2017; citation_volume=47; citation_issue=2; citation_pages=209-225; " /><meta name="citation_reference" content="citation_title=A meta-analytic examination of basal cardiovascular activity in posttraumatic stress disorder.; citation_author=Buckley TC; citation_author=Kaloupek DG; citation_journal_title=Psychosom Med; citation_year=2001; citation_volume=63; citation_issue=4; citation_pages=585-594; " /><meta name="citation_reference" content="citation_title=Hypertension in relation to posttraumatic stress disorder and depression in the US National Comorbidity Survey.; citation_author=Kibler JL; citation_author=Joshi K; citation_author=Ma M; citation_journal_title=Behav Med; citation_year=2009; citation_volume=34; citation_issue=4; citation_pages=125-132; " /><meta name="citation_reference" content="citation_title=Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women.; citation_author=Sumner JA; citation_author=Kubzansky LD; citation_author=Roberts AL; citation_journal_title=Psychol Med; citation_year=2016; citation_volume=46; citation_issue=15; citation_pages=3105-3116; " /><meta name="citation_reference" content="citation_title=Posttraumatic stress disorder and risk of obesity: systematic review and meta-analysis.; citation_author=Bartoli F; citation_author=Crocamo C; citation_author=Alamia A; citation_journal_title=J Clin Psychiatry; citation_year=2015; citation_volume=76; citation_issue=10; citation_pages=e1253-e1261; " /><meta name="citation_reference" content="citation_title=Posttraumatic stress disorder, overweight, and obesity: a systematic review and meta-analysis.; citation_author=Suliman S; citation_author=Anthonissen L; citation_author=Carr J; citation_journal_title=Harv Rev Psychiatry; citation_year=2016; citation_volume=24; citation_issue=4; citation_pages=271-293; " /><meta name="citation_reference" content="citation_title=Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: a systematic review and meta-analysis.; citation_author=van den Berk-Clark C; citation_author=Secrest S; citation_author=Walls J; citation_journal_title=Health Psychol; citation_year=2018; citation_volume=37; citation_issue=5; citation_pages=407-416; " /><meta name="citation_reference" content="citation_title=Type 2 diabetes among people with posttraumatic stress disorder: systematic review and meta-analysis.; citation_author=Vancampfort D; citation_author=Rosenbaum S; citation_author=Ward PB; citation_journal_title=Psychosom Med; citation_year=2016; citation_volume=78; citation_issue=4; citation_pages=465-473; " /><meta name="citation_reference" content="citation_title=The role of obesity in the association between posttraumatic stress disorder and incident diabetes.; citation_author=Scherrer JF; citation_author=Salas J; citation_author=Lustman PJ; citation_journal_title=JAMA Psychiatry; citation_year=2018; citation_volume=75; citation_issue=11; citation_pages=1189-1198; " /><meta name="citation_reference" content="citation_title=Changes in plasma lipid concentrations and risk of coronary artery disease in army veterans suffering from chronic posttraumatic stress disorder.; citation_author=Dzubur Kulenović A; citation_author=Kucukalić A; citation_author=Malec D; citation_journal_title=Croat Med J; citation_year=2008; citation_volume=49; citation_issue=4; citation_pages=506-514; " /><meta name="citation_reference" content="citation_title=Posttraumatic stress disorder and dyslipidemia: previous research and novel findings from patients with PTSD caused by myocardial infarction.; citation_author=Von Känel R; citation_author=Kraemer B; citation_author=Saner H; citation_author=Schmid JP; citation_author=Abbas CC; citation_author=Begré S; citation_journal_title=World J Biol Psychiatry; citation_year=2010; citation_volume=11; citation_issue=2; citation_pages=141-147; " /><meta name="citation_reference" content="citation_title=Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review.; citation_author=Edmondson D; citation_author=Kronish IM; citation_author=Shaffer JA; citation_author=Falzon L; citation_author=Burg MM; citation_journal_title=Am Heart J; citation_year=2013; citation_volume=166; citation_issue=5; citation_pages=806-814; " /><meta name="citation_reference" content="citation_title=Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study.; citation_author=Song H; citation_author=Fang F; citation_author=Arnberg FK; citation_journal_title=BMJ; citation_year=2019; citation_volume=365; citation_pages=l1255" /><meta name="citation_reference" content="citation_title=Association of posttraumatic stress disorder and incident ischemic heart disease in women veterans.; citation_author=Ebrahimi R; citation_author=Lynch KE; citation_author=Beckham JC; citation_journal_title=JAMA Cardiol; " /><meta name="citation_reference" content="citation_title=The association between post-traumatic stress disorder and coronary artery disease: a meta-analysis.; citation_author=Akosile W; citation_author=Colquhoun D; citation_author=Young R; citation_author=Lawford B; citation_author=Voisey J; citation_journal_title=Australas Psychiatry; citation_year=2018; citation_volume=26; citation_issue=5; citation_pages=524-530; " /><meta name="citation_reference" content="citation_title=Posttraumatic stress disorder and incident heart failure among a community-based sample of US veterans.; citation_author=Roy SS; citation_author=Foraker RE; citation_author=Girton RA; citation_author=Mansfield AJ; citation_journal_title=Am J Public Health; citation_year=2015; citation_volume=105; citation_issue=4; citation_pages=757-763; " /><meta name="citation_reference" content="citation_title=Risk of stroke among patients with post-traumatic stress disorder: nationwide longitudinal study.; citation_author=Chen MH; citation_author=Pan TL; citation_author=Li CT; citation_journal_title=Br J Psychiatry; citation_year=2015; citation_volume=206; citation_issue=4; citation_pages=302-307; " /><meta name="citation_reference" content="citation_title=Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder.; citation_author=Jordan HT; citation_author=Stellman SD; citation_author=Morabia A; citation_journal_title=J Am Heart Assoc; citation_year=2013; citation_volume=2; citation_issue=5; " /><meta name="citation_reference" content="citation_title=Meta-analysis of anxiety as a risk factor for cardiovascular disease.; citation_author=Emdin CA; citation_author=Odutayo A; citation_author=Wong CX; citation_author=Tran J; citation_author=Hsiao AJ; citation_author=Hunn BH; citation_journal_title=Am J Cardiol; citation_year=2016; citation_volume=118; citation_issue=4; citation_pages=511-519; " /><meta name="citation_reference" content="citation_title=Coronavirus immunoreactivity in individuals with a recent onset of psychotic symptoms.; citation_author=Severance EG; citation_author=Dickerson FB; citation_author=Viscidi RP; citation_journal_title=Schizophr Bull; citation_year=2011; citation_volume=37; citation_issue=1; citation_pages=101-107; " /><meta name="citation_reference" content="citation_title=Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder.; citation_author=Turner JH; citation_author=Neylan TC; citation_author=Schiller NB; citation_author=Li Y; citation_author=Cohen BE; citation_journal_title=Biol Psychiatry; citation_year=2013; citation_volume=74; citation_issue=11; citation_pages=861-866; " /><meta name="citation_reference" content="citation_title=Post-traumatic stress disorder and incidence of coronary heart disease: a twin study.; citation_author=Vaccarino V; citation_author=Goldberg J; citation_author=Rooks C; citation_journal_title=J Am Coll Cardiol; citation_year=2013; citation_volume=62; citation_issue=11; citation_pages=970-978; " /><meta name="citation_reference" content="citation_title=Post-traumatic stress disorder, coronary atherosclerosis, and mortality.; citation_author=Ahmadi N; citation_author=Hajsadeghi F; citation_author=Mirshkarlo HB; citation_author=Budoff M; citation_author=Yehuda R; citation_author=Ebrahimi R; citation_journal_title=Am J Cardiol; citation_year=2011; citation_volume=108; citation_issue=1; citation_pages=29-33; " /><meta name="citation_reference" content="citation_title=Associations between stress disorders and cardiovascular disease events in the Danish population.; citation_author=Gradus JL; citation_author=Farkas DK; citation_author=Svensson E; citation_journal_title=BMJ Open; citation_year=2015; citation_volume=5; citation_issue=12; " /><meta name="citation_reference" content="citation_title=Heart disease among adults exposed to the September 11, 2001 World Trade Center disaster: results from the World Trade Center Health Registry.; citation_author=Jordan HT; citation_author=Miller-Archie SA; citation_author=Cone JE; citation_author=Morabia A; citation_author=Stellman SD; citation_journal_title=Prev Med; citation_year=2011; citation_volume=53; citation_issue=6; citation_pages=370-376; " /><meta name="citation_reference" content="citation_title=The association of traumatic experiences and posttraumatic stress disorder with physical morbidity in old age: a German population-based study.; citation_author=Glaesmer H; citation_author=Brähler E; citation_author=Gündel H; citation_author=Riedel-Heller SG; citation_journal_title=Psychosom Med; citation_year=2011; citation_volume=73; citation_issue=5; citation_pages=401-406; " /><meta name="citation_reference" content="citation_title=Disaster-related posttraumatic stress disorder and physical health.; citation_author=Dirkzwager AJ; citation_author=van der Velden PG; citation_author=Grievink L; citation_author=Yzermans CJ; citation_journal_title=Psychosom Med; citation_year=2007; citation_volume=69; citation_issue=5; citation_pages=435-440; " /><meta name="citation_reference" content="citation_title=Post-traumatic stress disorder and cardiovascular diseases: a cohort study of men and women involved in cleaning the debris of the World Trade Center complex.; citation_author=Remch M; citation_author=Laskaris Z; citation_author=Flory J; citation_author=Mora-McLaughlin C; citation_author=Morabia A; citation_journal_title=Circ Cardiovasc Qual Outcomes; citation_year=2018; citation_volume=11; citation_issue=7; " /><meta name="citation_reference" content="citation_title=Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women.; citation_author=Sumner JA; citation_author=Kubzansky LD; citation_author=Elkind MS; citation_journal_title=Circulation; citation_year=2015; citation_volume=132; citation_issue=4; citation_pages=251-259; " /><meta name="citation_reference" content="citation_title=Post-traumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women.; citation_author=Gilsanz P; citation_author=Winning A; citation_author=Koenen KC; citation_journal_title=Psychol Med; citation_year=2017; citation_volume=47; citation_issue=8; citation_pages=1370-1378; " /><meta name="citation_reference" content="citation_title=Comorbid conditions explain the association between posttraumatic stress disorder and incident cardiovascular disease.; citation_author=Scherrer JF; citation_author=Salas J; citation_author=Cohen BE; citation_journal_title=J Am Heart Assoc; citation_year=2019; citation_volume=8; citation_issue=4; " /><meta name="citation_reference" content="citation_title=Deconstructing the gestalt: mechanisms of fear, threat, and trauma memory encoding.; citation_author=Maddox SA; citation_author=Hartmann J; citation_author=Ross RA; citation_author=Ressler KJ; citation_journal_title=Neuron; citation_year=2019; citation_volume=102; citation_issue=1; citation_pages=60-74; " /><meta name="citation_reference" content="citation_title=Common pathways and communication between the brain and heart: connecting post-traumatic stress disorder and heart failure.; citation_author=Wilson MA; citation_author=Liberzon I; citation_author=Lindsey ML; citation_journal_title=Stress; citation_year=2019; citation_volume=22; citation_issue=5; citation_pages=530-547; " /><meta name="citation_reference" content="citation_title=Context processing and the neurobiology of post-traumatic stress disorder.; citation_author=Liberzon I; citation_author=Abelson JL; citation_journal_title=Neuron; citation_year=2016; citation_volume=92; citation_issue=1; citation_pages=14-30; " /><meta name="citation_reference" content="citation_title=Neural mechanisms linking emotion with cardiovascular disease.; citation_author=Kraynak TE; citation_author=Marsland AL; citation_author=Gianaros PJ; citation_journal_title=Curr Cardiol Rep; citation_year=2018; citation_volume=20; citation_issue=12; citation_pages=128" /><meta name="citation_reference" content="citation_title=Association of predeployment heart rate variability with risk of postdeployment posttraumatic stress disorder in active-duty Marines.; citation_author=Marine Resiliency Study Team; citation_author=Minassian A; citation_author=Maihofer AX; citation_author=Baker DG; citation_author=Nievergelt CM; citation_author=Geyer MA; citation_author=Risbrough VB; citation_journal_title=JAMA Psychiatry; citation_year=2015; citation_volume=72; citation_issue=10; citation_pages=979-986; " /><meta name="citation_reference" content="citation_title=Five-minute heart rate variability can predict obstructive angiographic coronary disease.; citation_author=Kotecha D; citation_author=New G; citation_author=Flather MD; citation_author=Eccleston D; citation_author=Pepper J; citation_author=Krum H; citation_journal_title=Heart; citation_year=2012; citation_volume=98; citation_issue=5; citation_pages=395-401; " /><meta name="citation_reference" content="citation_title=Decreased nighttime heart rate variability is associated with increased stroke risk.; citation_author=Binici Z; citation_author=Mouridsen MR; citation_author=Køber L; citation_author=Sajadieh A; citation_journal_title=Stroke; citation_year=2011; citation_volume=42; citation_issue=11; citation_pages=3196-3201; " /><meta name="citation_reference" content="citation_title=Nocturnal autonomic balance and sleep in PTSD and resilience.; citation_author=Kobayashi I; citation_author=Lavela J; citation_author=Mellman TA; citation_journal_title=J Trauma Stress; citation_year=2014; citation_volume=27; citation_issue=6; citation_pages=712-716; " /><meta name="citation_reference" content="citation_title=Posttraumatic stress disorder diagnosis is associated with reduced parasympathetic activity during sleep in US veterans and military service members of the Iraq and Afghanistan wars.; citation_author=Ulmer CS; citation_author=Hall MH; citation_author=Dennis PA; citation_author=Beckham JC; citation_author=Germain A; citation_journal_title=Sleep; citation_year=2018; citation_volume=41; citation_issue=12; " /><meta name="citation_reference" content="citation_title=Abnormal sympathetic neural recruitment patterns and hemodynamic responses to cold pressor test in women with post-traumatic stress disorder.; citation_author=Yoo JK; citation_author=Badrov MB; citation_author=Huang M; citation_journal_title=Am J Physiol Heart Circ Physiol; citation_year=2020; " /><meta name="citation_reference" content="citation_title=Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression.; citation_author=Passos IC; citation_author=Vasconcelos-Moreno MP; citation_author=Costa LG; citation_journal_title=Lancet Psychiatry; citation_year=2015; citation_volume=2; citation_issue=11; citation_pages=1002-1012; " /><meta name="citation_reference" content="citation_title=Assessment of plasma C-reactive protein as a biomarker of posttraumatic stress disorder risk.; citation_author=Marine Resiliency Study Team; citation_author=Eraly SA; citation_author=Nievergelt CM; citation_author=Maihofer AX; citation_journal_title=JAMA Psychiatry; citation_year=2014; citation_volume=71; citation_issue=4; citation_pages=423-431; " /><meta name="citation_reference" content="citation_title=A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention.; citation_author=Boscarino JA; citation_journal_title=Psychosom Med; citation_year=2008; citation_volume=70; citation_issue=6; citation_pages=668-676; " /><meta name="citation_reference" content="citation_title=Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease.; citation_author=Brudey C; citation_author=Park J; citation_author=Wiaderkiewicz J; citation_author=Kobayashi I; citation_author=Mellman TA; citation_author=Marvar PJ; citation_journal_title=Am J Physiol Regul Integr Comp Physiol; citation_year=2015; citation_volume=309; citation_issue=4; citation_pages=R315-R321; " /><meta name="citation_reference" content="citation_title=Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations.; citation_author=Flory JD; citation_author=Yehuda R; citation_journal_title=Dialogues Clin Neurosci; citation_year=2015; citation_volume=17; citation_issue=2; citation_pages=141-150; " /><meta name="citation_reference" content="citation_title=Posttraumatic stress disorder and inflammation: untangling issues of bidirectionality.; citation_author=Sumner JA; citation_author=Nishimi KM; citation_author=Koenen KC; citation_author=Roberts AL; citation_author=Kubzansky LD; citation_journal_title=Biol Psychiatry; citation_year=2020; citation_volume=87; citation_issue=10; citation_pages=885-897; " /><meta name="citation_reference" content="citation_title=An overview of translationally informed treatments for posttraumatic stress disorder: animal models of Pavlovian fear conditioning to human clinical trials.; citation_author=Bowers ME; citation_author=Ressler KJ; citation_journal_title=Biol Psychiatry; citation_year=2015; citation_volume=78; citation_issue=5; citation_pages=E15-E27; " /><meta name="citation_reference" content="citation_title=175 Years of progress in PTSD therapeutics: learning from the past.; citation_author=Stein MB; citation_author=Rothbaum BO; citation_journal_title=Am J Psychiatry; citation_year=2018; citation_volume=175; citation_issue=6; citation_pages=508-516; " /><meta name="citation_reference" content="citation_title=Stress-induced sensitization of angiotensin II hypertension is reversed by blockade of angiotensin-converting enzyme or tumor necrosis factor-α.; citation_author=Xue B; citation_author=Yu Y; citation_author=Wei SG; citation_journal_title=Am J Hypertens; citation_year=2019; citation_volume=32; citation_issue=9; citation_pages=909-917; " /><meta name="citation_reference" content="citation_title=Angiotensin II type 2 receptor-expressing neurons in the central amygdala influence fear-related behavior.; citation_author=Yu Z; citation_author=Swiercz AP; citation_author=Moshfegh CM; citation_journal_title=Biol Psychiatry; citation_year=2019; citation_volume=86; citation_issue=12; citation_pages=899-909; " /><meta name="citation_reference" content="citation_title=Individual differences in the peripheral immune system promote resilience versus susceptibility to social stress.; citation_author=Hodes GE; citation_author=Pfau ML; citation_author=Leboeuf M; citation_journal_title=Proc Natl Acad Sci U S A; citation_year=2014; citation_volume=111; citation_issue=45; citation_pages=16136-16141; " /><meta name="citation_reference" content="citation_title=Interleukin-6 knockout reverses macrophage differentiation imbalance and alleviates cardiac dysfunction in aging mice.; citation_author=Wang Y; citation_author=Zhu S; citation_author=Wei W; citation_journal_title=Aging (Albany NY); citation_year=2020; citation_volume=12; citation_issue=20; citation_pages=20184-20197; " /><meta name="citation_reference" content="citation_title=Current status of animal models of posttraumatic stress disorder: behavioral and biological phenotypes, and future challenges in improving translation.; citation_author=Deslauriers J; citation_author=Toth M; citation_author=Der-Avakian A; citation_author=Risbrough VB; citation_journal_title=Biol Psychiatry; citation_year=2018; citation_volume=83; citation_issue=10; citation_pages=895-907; " /><meta name="citation_reference" content="citation_title=10 Years of GWAS discovery: biology, function, and translation.; citation_author=Visscher PM; citation_author=Wray NR; citation_author=Zhang Q; citation_journal_title=Am J Hum Genet; citation_year=2017; citation_volume=101; citation_issue=1; citation_pages=5-22; " /><meta name="citation_reference" content="citation_title=Rab27-dependent exosome production inhibits chronic inflammation and enables acute responses to inflammatory stimuli.; citation_author=Alexander M; citation_author=Ramstead AG; citation_author=Bauer KM; citation_journal_title=J Immunol; citation_year=2017; citation_volume=199; citation_issue=10; citation_pages=3559-3570; " /><meta name="citation_reference" content="citation_title=International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci.; citation_author=Nievergelt CM; citation_author=Maihofer AX; citation_author=Klengel T; citation_journal_title=Nat Commun; citation_year=2019; citation_volume=10; citation_issue=1; citation_pages=4558" /><meta name="citation_reference" content="citation_title=Estimation of complex effect-size distributions using summary-level statistics from genome-wide association studies across 32 complex traits.; citation_author=Zhang Y; citation_author=Qi G; citation_author=Park JH; citation_author=Chatterjee N; citation_journal_title=Nat Genet; citation_year=2018; citation_volume=50; citation_issue=9; citation_pages=1318-1326; " /><meta name="citation_reference" content="citation_title=Identification of 64 novel genetic loci provides an expanded view on the genetic architecture of coronary artery disease.; citation_author=van der Harst P; citation_author=Verweij N; citation_journal_title=Circ Res; citation_year=2018; citation_volume=122; citation_issue=3; citation_pages=433-443; " /><meta name="citation_reference" content="citation_title=Genome-wide association analyses of post-traumatic stress disorder and its symptom subdomains in the Million Veteran Program.; citation_author=Department of Veterans Affairs Cooperative Studies Program (no. 575B); citation_author=Stein MB; citation_author=Levey DF; citation_author=Cheng Z; citation_journal_title=Nat Genet; citation_year=2021; citation_volume=53; citation_issue=2; citation_pages=174-184; " /><meta name="citation_reference" content="citation_title=‘Mendelian randomization’: can genetic epidemiology contribute to understanding environmental determinants of disease?; citation_author=Smith GD; citation_author=Ebrahim S; citation_journal_title=Int J Epidemiol; citation_year=2003; citation_volume=32; citation_issue=1; citation_pages=1-22; " /><meta name="citation_reference" content="citation_title=A review of instrumental variable estimators for mendelian randomization.; citation_author=Burgess S; citation_author=Small DS; citation_author=Thompson SG; citation_journal_title=Stat Methods Med Res; citation_year=2017; citation_volume=26; citation_issue=5; citation_pages=2333-2355; " /><meta name="citation_reference" content="citation_title=A global overview of pleiotropy and genetic architecture in complex traits.; citation_author=Watanabe K; citation_author=Stringer S; citation_author=Frei O; citation_journal_title=Nat Genet; citation_year=2019; citation_volume=51; citation_issue=9; citation_pages=1339-1348; " /><meta name="citation_reference" content="citation_title=Causal associations of adiposity and body fat distribution with coronary heart disease, stroke subtypes, and type 2 diabetes mellitus: a mendelian randomization analysis.; citation_author=UCLEB Consortium; METASTROKE Consortium; citation_author=Dale CE; citation_author=Fatemifar G; citation_author=Palmer TM; citation_journal_title=Circulation; citation_year=2017; citation_volume=135; citation_issue=24; citation_pages=2373-2388; " /><meta name="citation_reference" content="citation_title=Education and coronary heart disease: mendelian randomisation study.; citation_author=Tillmann T; citation_author=Vaucher J; citation_author=Okbay A; citation_journal_title=BMJ; citation_year=2017; citation_volume=358; citation_pages=j3542" /><meta name="citation_reference" content="citation_title=Association of economic status and educational attainment with posttraumatic stress disorder: a mendelian randomization study.; citation_author=Psychiatric Genomics Consortium Posttraumatic Stress Disorder Working Group; citation_author=Polimanti R; citation_author=Ratanatharathorn A; citation_author=Maihofer AX; citation_journal_title=JAMA Netw Open; citation_year=2019; citation_volume=2; citation_issue=5; " /><meta name="citation_reference" content="citation_title=Leukocytes link local and systemic inflammation in ischemic cardiovascular disease: an expanded “cardiovascular continuum.”; citation_author=Libby P; citation_author=Nahrendorf M; citation_author=Swirski FK; citation_journal_title=J Am Coll Cardiol; citation_year=2016; citation_volume=67; citation_issue=9; citation_pages=1091-1103; " /><meta name="citation_reference" content="citation_title=Chronic variable stress activates hematopoietic stem cells.; citation_author=Heidt T; citation_author=Sager HB; citation_author=Courties G; citation_journal_title=Nat Med; citation_year=2014; citation_volume=20; citation_issue=7; citation_pages=754-758; " /><meta name="citation_reference" content="citation_title=Myocardial infarction accelerates atherosclerosis.; citation_author=Dutta P; citation_author=Courties G; citation_author=Wei Y; citation_journal_title=Nature; citation_year=2012; citation_volume=487; citation_issue=7407; citation_pages=325-329; " /><meta name="citation_reference" content="citation_title=Splenic metabolic activity predicts risk of future cardiovascular events: demonstration of a cardiosplenic axis in humans.; citation_author=Emami H; citation_author=Singh P; citation_author=MacNabb M; citation_journal_title=JACC Cardiovasc Imaging; citation_year=2015; citation_volume=8; citation_issue=2; citation_pages=121-130; " /><meta name="citation_reference" content="citation_title=An inflammatory pathway links atherosclerotic cardiovascular disease risk to neural activity evoked by the cognitive regulation of emotion.; citation_author=Gianaros PJ; citation_author=Marsland AL; citation_author=Kuan DC; citation_journal_title=Biol Psychiatry; citation_year=2014; citation_volume=75; citation_issue=9; citation_pages=738-745; " /><meta name="citation_reference" content="citation_title=Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study.; citation_author=Tawakol A; citation_author=Ishai A; citation_author=Takx RA; citation_journal_title=Lancet; citation_year=2017; citation_volume=389; citation_issue=10071; citation_pages=834-845; " /><meta name="citation_reference" content="citation_title=Posttraumatic stress disorder is associated with enhanced interleukin-6 response to mental stress in subjects with a recent myocardial infarction.; citation_author=Lima BB; citation_author=Hammadah M; citation_author=Wilmot K; citation_journal_title=Brain Behav Immun; citation_year=2019; citation_volume=75; citation_pages=26-33; " /><meta name="citation_reference" content="citation_title=Understanding the heart-brain axis response in COVID-19 patients: a suggestive perspective for therapeutic development.; citation_author=Lionetti V; citation_author=Bollini S; citation_author=Coppini R; citation_journal_title=Pharmacol Res; citation_year=2021; citation_volume=168; " /><meta name="citation_pdf_url" content="https://jamanetwork.com/journals/jamacardiology/articlepdf/2781972/jamacardiology_odonnell_2021_sc_210001_1633734735.77532.pdf" /> <meta name="citation_xml_url" content="https://datafeed.jamanetwork.com/journals/jamacardiology/xml/2781972" /> <title>Posttraumatic Stress Disorder and Cardiovascular Disease: State of the Science, Knowledge Gaps, and Research Opportunities | Psychiatry and Behavioral Health | JAMA Cardiology | JAMA Network</title> <meta name="description" content="This study critically reviews the available evidence on the association of posttraumatic stress disorder with cardiovascular disease from population,"> <link rel="canonical" href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781972" /> <script src="//cdn.jamanetwork.com/UI/app/dist/head.min.js?v=638677764511843155"></script> <script src="https://r451.jamanetwork.com/script.js" defer></script> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_HeaderScript"> <meta class="SCM-SharedWidgets-AsyncHeaderAdLoader" data-url="/AMA/AdTag/AMA_AdTag_HeaderScript" data-params="{"parameters":{"siteName":"jamacardiology","siteId":192,"journalId":184,"adDisplay":0,"adSection":"abstract","adPosition":"","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"> </div> </head> <body data-sitename="jamacardiology" class="pg_abstract " data-thm="cardi"> <script> var App = App || {}; App.suppressAds = App.suppressAds || !!document.getElementsByClassName('suppress-ads').length; App.suppressGtm = App.suppressGtm || !!document.getElementsByClassName('suppress-gtm').length; </script> <div id="ad-interstitial" class="ad-interstitial"> <script defer> googletag.cmd.push(function() { if (App.suppressAds) { return; } // Define a web interstitial ad slot. let interstitialSlot = googletag.defineOutOfPageSlot( App.Ads.adPath + '/abstract', googletag.enums.OutOfPageFormat.INTERSTITIAL, ); if (interstitialSlot) { App.Ads.slots[13] = interstitialSlot; // Enable optional interstitial triggers and register the slot. interstitialSlot .setTargeting('pos', ['interstitial']) .addService(googletag.pubads()) .setConfig({ interstitial: { triggers: { navBar: true, unhideWindow: true, }, }, }); googletag.display(interstitialSlot); googletag.pubads().refresh([interstitialSlot], { changeCorrelator: false }); googletag.enableServices(); } }); </script> </div> <a class="accessible js-skip-to-navigation" href="#skip-to-navigation">[Skip to Navigation]</a> <noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-WNKSNP" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-WNKSNP');</script> <span class="hide tagmanagervalue" data-attribute="productName" data-value="JAMA Cardiology" data-type="string"></span> <form method="post" action="./2781972" id="webform" class="m0"> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="TKCZn/5jN70/BVM2wpGfJgZevIKAJ5i2XuR3PRoRo8XMVPvdjYtuedThxYjRhViHOerryrB0I66HVTp7HtJvQIjZBRs=" /> </div> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="2FAFABAE" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="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" /> </div> <input id="hdnSiteID" type="hidden" value="192" /> <input id="hdnDomain" type="hidden" value=".jamanetwork.com" /> <section class="master-header"> <script type='text/javascript'> var App = App || {}; App.LoginUserInfo = { isInstLoggedIn: [0], currentSessionId: 'bhcxqgyob5g0hin0n45wz4kh' }; </script> <input name="ctl00$ctl00$BodyContent$Header$hfGlobalSearchSiteURL" type="hidden" id="hfGlobalSearchSiteURL" value="https://jamanetwork.com/" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsPaidUser" type="hidden" id="hfAppIsPaidUser" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsMember" type="hidden" id="hfAppIsMember" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppSubscribedTo" type="hidden" id="hfAppSubscribedTo" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsIndividual" type="hidden" id="hfAppIsIndividual" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppHasAccess" type="hidden" id="hfAppHasAccess" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsReferredFromGoogle" type="hidden" id="hfAppIsReferredFromGoogle" value="False" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrAutoSuggestMinimumCharactersLength" type="hidden" id="hfSolrAutoSuggestMinimumCharactersLength" value="2" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalName" type="hidden" id="hfSolrJournalName" value="JAMA Cardiology" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalID" type="hidden" id="hfSolrJournalID" value="J184" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsLucy" type="hidden" id="hfAppIsLucy" value="false" /> <div class="header-wrap"> <header class="header"> <div class="widget-GdprCookieBanner widget-instance-GdprCookieBanner"> <div class="gdpr-cookie-wrapper js-gdpr-banner"> <div class="gdpr-cookie-body"> Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our <a href="https://jamanetwork.com/pages/privacy-policy#cookies">Cookie Policy</a> <span class="pipe">|</span> <a href="javascript:;" class="js-gdpr-cookie-acceptLink at-acceptgdpr">Continue</a> </div> <input id="hdnDomain" type="hidden" value=".jamanetwork.com" /> <input id="hdnDomainGdpr" type="hidden" value=".jamanetwork.com" /> <input id="hdnClientIdGdpr" type="hidden" value="3" /> </div> </div> <div class="network-bar"> <a class="jama-network" href="/" title="JAMA Network Home"> <img alt="JAMA Network Home" class="title-image" width="443" height="52" src="//cdn.jamanetwork.com/UI/app/svg/Jama_Network_Logo.svg"> </a> </div> <a class="nav-toggler" href="#nav"> <div class="nav-toggler-indicator"> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> </div> <div class="nav-toggler-site"> <span id="BodyContent_Header_siteFullNamenav" class="nav-toggler-microsite"><span class='network'>JAMA</span> Cardiology</span> </div> </a> <nav id="nav" class="nav hide" > <div class="nav-journal-level sb-nav-journal-level"> <a href="https://jamanetwork.com/journals/jamacardiology" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_0" class="home">Home</a><a href="https://jamanetwork.com/journals/jamacardiology/newonline" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_1" class="new-online">New Online</a><a href="https://jamanetwork.com/journals/jamacardiology/currentissue" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_2" class="current-issue">Current Issue</a><a href="https://jamanetwork.com/journals/jamacardiology/pages/for-authors" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_3" class="for-authors">For Authors</a> </div> <div class="nav-journals"> <div class="widget-SelfServeContent widget-instance-HamburgerPublicationMenu"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="HamburgerPublicationMenu" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .nav-journals {margin-bottom: 1em;} .nav-heading {color: #B9B9B9;border-bottom: 0;border-top: 1px solid #242424;font-size: 1.15em;font-weight: 400;margin: 0;padding: .7em .75em .25em;text-transform: uppercase;} a.no-bullet:before {content:none !important;} .nav-heading {font-size: 1.15em;margin-bottom:0;padding-left: 38px;} /* .nav-journals a.theme-jama {background-color: #242424;border-bottom: 1px solid #fff;border-top: 1px solid #fff;color: #fff;font-size: 1.15em;margin-bottom: 8px;padding: 11px 0 9px 37px;} .nav-journals a.theme-jama::before {background: unset;content: "\e91b";display: none;font-family: ama_icons !important;font-size: 1.25em;line-height: 1;} .nav-journals a.theme-jama-network-open {border-bottom:0;} */ .nav .widget-instance-HamburgerPublicationMenu a {padding-left: 36px;} .fake-ribbon {border-left: 8px solid #BE1E32;} .fake-ribbon a:before {content:none;} .nav .widget-instance-HamburgerPublicationMenu .fake-ribbon a {padding-left:30px;} .nav-journals a.theme-plus:before {background:#d71635;} .nav-journals a.theme-jama-network-open {border-bottom:0;} </style> <div class="fake-ribbon"><a href="/journals/jamacardiology/pages/jama-cardiology-author-interviews">Podcast</a></div> <h2 class="nav-heading">JAMA+</h2> <a href="/channels/ai" class="theme-plus">AI</a> <h2 class="nav-heading">Journals</h2> <a href="/journals/jama" class="theme-jama">JAMA</a> <a href="/journals/jamanetworkopen" class="theme-jama-network-open">JAMA Network Open</a> <a href="/journals/jamacardiology" class="theme-jama-cardiology">JAMA Cardiology</a> <a href="/journals/jamadermatology" class="theme-jama-dermatology">JAMA Dermatology</a> <a href="/journals/jama-health-forum" class="theme-jama-health-forum">JAMA Health Forum</a> <a href="/journals/jamainternalmedicine" class="theme-jama-internal-medicine">JAMA Internal Medicine</a> <a href="/journals/jamaneurology" class="theme-jama-neurology">JAMA Neurology</a> <a href="/journals/jamaoncology" class="theme-jama-oncology">JAMA Oncology</a> <a href="/journals/jamaophthalmology" class="theme-jama-ophthalmology">JAMA Ophthalmology </a> <a href="/journals/jamaotolaryngology" class="theme-jama-otolaryngology-head-neck-surgery">JAMA Otolaryngology–Head & Neck Surgery</a> <a href="/journals/jamapediatrics" class="theme-jama-pediatrics">JAMA Pediatrics</a> <a href="/journals/jamapsychiatry" class="theme-jama-psychiatry">JAMA Psychiatry</a> <a href="/journals/jamasurgery" class="theme-jama-surgery">JAMA Surgery</a> <a href="/journals/archneurpsyc" class="theme-archives-of-neurology-psychiatry-1919-1959-">Archives of Neurology & Psychiatry (1919-1959)</a> </div> </div> </div> <div class="nav-network-other"> <a href="https://edhub.ama-assn.org/jn-learning" id="BodyContent_Header_rptOtherResources_aItemResourceList_0" class="is-b link-jn-learning-cme" target="_blank">JN Learning / CME</a><a href="https://store.jamanetwork.com/index.aspx?productcode=180" id="BodyContent_Header_rptOtherResources_aItemResourceList_1" class="is-b link-subscribe" target="_blank">Subscribe</a><a href="https://careers.jamanetwork.com/" id="BodyContent_Header_rptOtherResources_aItemResourceList_2" class="is-b link-jobs" target="_blank">Jobs</a><a href="https://jamanetwork.com/pages/resources-for-librarians" id="BodyContent_Header_rptOtherResources_aItemResourceList_3" class="is-b link-institutions-librarians">Institutions / Librarians</a><a href="https://jamanetwork.com/pages/reprints-and-permissions" id="BodyContent_Header_rptOtherResources_aItemResourceList_4" class="is-b link-reprints-permissions" rel="nofollow">Reprints & Permissions</a> </div> <div class="white text-xxs"> <div class="p05 ml4 mr3 mb1 mt10 flex hamburger-menu-legal"> <a href="/pages/conditions-of-use" class="p0" rel="nofollow">Terms of Use</a> <span class="pl1 pr1">| </span> <a href="/pages/privacy-policy" class="p0" rel="nofollow">Privacy Policy</a> <span class="pl1 pr1">| </span> <a href="/pages/accessibility-statement" class="p0" rel="nofollow">Accessibility Statement</a> </div> <div class="ta-c"> <span class="pb1">2024 American Medical Association. All Rights Reserved</span> </div> </div> </nav> <a class="toolbar-search-trigger is-b" data-mobile-tog-target=".site-search"></a> <div id="site-search" role="search" class="site-search"> <div class="site-search-bar"> <div role="search"> <select name="ctl00$ctl00$BodyContent$Header$ddlForSearch" id="BodyContent_Header_ddlForSearch" Name="dropDownList" class="cs-select cs-skin-border" title="Search Site Selector" role="options" aria-labelledby="searchLabel"> <option value="J*">Search All</option> <option value="3">JAMA</option> <option value="214">JAMA Network Open</option> <option value="192">JAMA Cardiology</option> <option value="12">JAMA Dermatology</option> <option value="261">JAMA Forum Archive</option> <option value="193">JAMA Health Forum</option> <option value="15">JAMA Internal Medicine</option> <option value="16">JAMA Neurology</option> <option value="159">JAMA Oncology</option> <option value="17">JAMA Ophthalmology</option> <option value="18">JAMA Otolaryngology–Head & Neck Surgery</option> <option value="19">JAMA Pediatrics</option> <option value="14">JAMA Psychiatry</option> <option value="20">JAMA Surgery</option> <option value="23">Archives of Neurology & Psychiatry</option> </select> </div> <div class="search-input-container"> <input type="search" name="textbox" autocomplete="off" role="textbox" id="search-term" aria-labelledby="searchLabel" class="search-term at-microsite-search-term" placeholder="Enter Search Term" maxlength="255" title="Enter Search Term"> <ul id="umbrellaSiteAutoCompleteResults" class="term-list hidden"></ul> <label style="display:none" for="umbrellaSiteSearchInputHint" id="searchLabel">Input Search Term</label> <input class="searchTerm search-input" name="textbox" role="textbox" type="text" id="umbrellaSiteSearchInputHint" aria-labelledby="searchLabel" title="Input Search Term" autocomplete="off"> </div>  <a name="button" role="button" class="search-button is-b js-search-button" alt="search button" href="/searchresults"></a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_auth" class="auth"> <a class="auth--trigger is-b is-a" href="javascript:;"> <span id="BodyContent_Header_GlobalSignIn_spnUserFullName" class="user-full-name">Sign In</span> </a> <div class="auth--dropdown js-signIn-dropdown"> <div class="auth--option auth--ind"> <div id="BodyContent_Header_GlobalSignIn_divUserFullName" class="auth--ind-user"></div> <div id="BodyContent_Header_GlobalSignIn_divIndSignIn" class="auth--ind-auth"> <div class="auth--title">Individual Sign In</div> <a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972" id="BodyContent_Header_GlobalSignIn_oauthSignInLink" rel="nofollow" class="auth--ind-sign-in">Sign in</a><a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972" id="BodyContent_Header_GlobalSignIn_oauthSignUpLink" rel="nofollow" class="auth--ind-create">Create an Account</a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_divInstSignIn" class="auth--option auth--inst"> <div class="auth--inst-auth"> <div class="auth--title">Access through your institution</div> <a href="/signinshibboleth?returnUrl=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972" id="BodyContent_Header_GlobalSignIn_institutionSignIn" rel="nofollow" class="auth--shib">Sign In</a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_divPurchaseOptions" class="auth--option auth--purchase"> <div class="auth--title">Purchase Options:</div> <a id="BodyContent_Header_GlobalSignIn_lnkBuyArticle" class="auth--buy" href="https://jamanetwork.com/oauthsignin?return_url=https://store.jamanetwork.com/CustomerType.aspx?articleId=2781972">Buy this article</a> <div class="widget-DeepDyve widget-instance-AMAv2_DeepDyve"> <a rel="nofollow" data-doi="10.1001/jamacardio.2021.2530" data-fieldname="journal_doi" data-issneissn="2380-6583" data-affiliate="JAMA" class="deepDiveLink auth--shib deep-dive-wrap js-deepdyve-link" href="https://www.deepdyve.com/doc-view?docId=10.1001/jamacardio.2021.2530&fieldName=journal_doi&affiliateId=JAMA" target="_blank">Rent this article</a> </div> <a id="BodyContent_Header_GlobalSignIn_lnkSubscribeJournal" class="auth--subscribe" rel="nofollow" href="https://store.jamanetwork.com/index.aspx?productcode=180">Subscribe to the JAMA Cardiology journal</a> </div> </div> </div> </header> </div> <div class="editors-choice-header"> </div> <div id="BodyContent_Header_divAds" class="header-ad-wrap sb-background-primary-dark"> <div class="leader-ad desktop-only"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_LeaderboardAd"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_LeaderboardAd" data-params="{"parameters":{"siteName":"jamacardiology","siteId":192,"journalId":184,"adDisplay":1,"adSection":"abstract","adPosition":"atf","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> </div>  </section> <section class="master-main"> <span class="hide tagmanagervalue" data-attribute="template" data-value="abstract" data-type="string"></span> <script type="application/ld+json"> { "@context": "https://schema.org/", "@type": "Article", "headline": "Posttraumatic Stress Disorder and Cardiovascular Disease: State of the Science, Knowledge Gaps, and Research", "author": "Christopher J. O’Donnell, MD, MPH", "url": "https://jamanetwork.com/journals/jamacardiology/fullarticle/2781972", "datePublished": "2021-10-01", "description": "This study critically reviews the available evidence on the association of posttraumatic stress disorder with cardiovascular disease from population, basic, and genomic research as well as from clinical and translational research.", "publisher": { "@type": "Organization", "name": "JAMA Network", "logo": { "@type": "ImageObject", "url": "//cdn.jamanetwork.com/UI/app/img/favicons/cardiology/favicon.ico" } }, "image": [ "https://cdn.jamanetwork.com/ama/content_public/journal/cardiology/938788/hsc210001f1_1633734735.93036.png?Expires=2147483647&Signature=3EKZeIarA2mJ0zVj2SnZ-KAizbfzChPcLvNBlmsxEHCHARd4gBA8nwAzBP9LZ17Qjn1i2KhUhmMu-t65ccVUK5c8n7iLHQM~07Fux5rXjwpJmR0LMdpD59rKG6tXEPkvlF~1rSzW0eny4VCee2C0YDKrSfCYi5HG-POhPWymIN2SRDp8m3T8u28Da2SqOYrkgIxH1j5F86gMg5VOLIPTCQdTSwIMaG2edtjdP6G23fRyur31VBW9rKY2FB3OB7eg9lEGxYAPqikQsNf0PEV9GLpol9ypo8rqVIAPfNyN8DWBZZvgy0~EVau4XgRJJbhTTzcCVNX6I-dJAUdJGBnFSQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/cardiology/938788/hsc210001t1_1633734735.96033.png?Expires=2147483647&Signature=bvn9s2a8ALWvCtROLrERLUpr21Xjvb4eZ2~4aL5p6TFnJeWKpN2FHIVT5Shs8V1Nc61nzaFImCm1t3gB2OWXbBnZuDeZ7MCKzX~-vJlBF4a3Dqvvd23ly6b0i7NkkAj-4Jsyn65mciHkX4hAjREKUPAPtXX541j05xibk9exyA42aktnvskreurdVtMOte1tjWPgl91LNGldmhh~RmTxXNwz2dIhc~zM8ft3qizBzEeVduaFB9FqtlRPl6BKNM7KT7o7n~WazX1wGdqdoG8kfnQ~WpRthi5oHOmaerN~FHlpzQykcyazTwVugykCCr07zRGA0XuGIgnVBB4CeeDiVQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/cardiology/938788/hsc210001t2_1633734735.98038.png?Expires=2147483647&Signature=D6YyOWHNqMQWq3L8LGjSGOPgFFlEint4glV2Kkg9a-whnv4tV3O78KilMm7yc~7LRljOuZSZ-4cbmaHysVWbId9kzm8yokk-50CbiCN5DG-ji6UL~af6hIMS7ODEDpPUIkofVYVtTMJfOxhO-V1NFB88446xWRs-c8j5IHgEFhCqa~ZQf10ny5tCI0ibrYb3KLNBSTljQyaESqkGz5DtOox70oc2NjDIAe61ABBvR5scISo6rjdNGalxGP2ZcBd0XYrnjLUA2kaMtEgeLSZSLVZgMoA0ZJSu2DsR1eQk7q2QLc49QIvr1vd1Rc-BW~oRJj34a0kxL2UbAkivqCSbMA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" ], "articleSection": [ "Introduction", "Evidence From Epidemiological Studies Regarding PTSD as a CVD Risk Factor", "Pathophysiology of PTSD as a CVD Risk Factor", "Resources Needed to Optimize Basic Science Research", "Evidence From Genomic Science Including Mendelian Randomization", "Evidence From Clinical and Translational Science", "Conclusions", "Article Information" ], "keyWords": "cardiovascular diseases, stress disorders, post-traumatic, translational research, heart disease risk factors, genome" } </script> <div class="widget-UserContentAccessWrite widget-instance-AMA_UserContentAccessWrite_AbstractView"> <div class="SCM-SharedWidgets-LocalStorage-UserContentAccessWrite" data-values='{"id":"2781972","type":"Article","date":"11/24/2024 3:55:02 PM"}'></div> </div> <a id="skip-to-navigation" href="#" tabindex="-1"></a> <div class="ymal--leader hide-small"> <div id="BodyContent_PageContent_ymalPersonalized" class="ymal--personalized js-ymal-personalized hide"> <div class="widget-WidgetLoader widget-instance-AMA_PersonalizedContent_AbstractView_Leaderboard"> <div class="SCM-SharedWidgets-AsyncWidgetLoader" data-url="/Personalization/PersonalizedContent/AMA_PersonalizedContent_AbstractView_Leaderboard" data-params="{"parameters":{"resourceIdToExclude":2781972,"resourceTypeToExclude":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div id="BodyContent_PageContent_ymalCurated" class="ymal--curated js-ymal-curated"> <div class="ymal row"> </div> </div> </div> <div class="content pb0"> <a id="top"></a> <div class="article-content"> <div class="social-share hide" data-share-journal="JAMACardio" data-share-title="Posttraumatic Stress Disorder and Cardiovascular Disease"> <a class="st-custom-button addthis_button_twitter is-b toolbar-twitter toolbar-share" data-network="twitter" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">X</span> </a> <a class="st-custom-button addthis_button_facebook is-b toolbar-facebook toolbar-share" data-network="facebook" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">Facebook</span> </a> <div class="toolbar-share-more"> <a class="st-custom-button addthis_button_linkedin is-b toolbar-linkedin toolbar-share" data-network="linkedin" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">LinkedIn</span> </a> </div> <a class="toolbar-share-more-link is-a" rel="nofollow" data-tog-target=".social-share .toolbar-share-more"><span class="icon icon-carrot_down social-arrow"></span>More</a> </div> <div class="widget-ArticleLinks widget-instance-AMA_ErrataArticleLinks_Abstract"> </div> <div class="widget-ArticleLinks widget-instance-AMA_ArticleLinks_ToErrata_Abstract"> </div> <div class="widget-ArticleNavLinks widget-instance-AMA_ArticleNavLinks_Abstract"> <a class="toc-link btn" href="https://jamanetwork.com/journals/jamacardiology/issue/6/10">This Issue</a> </div> <div id="BodyContent_PageContent_divArticleLevelMetrics" class="article-metrics-wrapper"> <div class="widget-ArticleLevelMetrics widget-instance-AMA_ArticleMetrics"> <div class="artmet-condensed-wrap clearfix"> <div class="artmet-condensed-stats clearfix"> <div class="artmet-item artmet-views"> <span class="artmet-text sb-sc">Views</span> <span class="artmet-number sb-sc">4,116</span> </div> <div class="artmet-item artmet-citations"> <a class="artmet-citations-link" href="https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=silverchair&SrcAuth=WosAPI&KeyUT=WOS:000673032000002&DestLinkType=FullRecord&DestApp=WOS_CPL" target="_blank"> <span class="artmet-text">Citations</span> <span class="artmet-number">65</span> </a> </div> <div class="artmet-item artmet-altmetric"> <div class="widget-AltmetricLink widget-instance-AMAv2_ArticleLevelMetrics_AltmetricLinkSummary">  <div id="altmetricEmbedId" class='altmetric-embed' data-link-target="_blank" data-badge-type="text" data-hide-no-mentions="false" data-doi="10.1001/jamacardio.2021.2530" ></div> </div> </div> </div> <div class="artmet-modal-trigger-wrap"> <a rel="nofollow" class="artmet-modal-trigger" data-article-id="2781972"><i class="icon-metrics"></i><span>View Metrics</span></a> </div> </div> </div> </div> <ul class="toolbar-trigger"> <li class="toolbar-pdf-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-pdf is-b" data-trigger=".abstract-toolbar .toolbar-pdf"><span class="toolbar-pdf-text"><span class="toolbar-link-text-extra">Download </span><span class="toolbar-link-text">PDF</span></span></a> </li> <li class="toolbar-full-text-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-full-text is-b" data-url="" data-article-id="2781972" data-trigger=".abstract-toolbar .toolbar-full-text">Full Text</a> </li> <li class="toolbar-share-wrap toolbar-tool-wrap"> <div class="toolbar-tool toolbar-share is-b"> <a class="toolbar-share-more-link">Share</a> <div class="toolbar-share-more"> <a class="toolbar-share toolbar-twitter is-b" rel="nofollow" data-trigger=".social-share .toolbar-twitter"><span class="share-text">X</span></a> <a class="toolbar-share toolbar-facebook is-b" rel="nofollow" data-trigger=".social-share .toolbar-facebook"><span class="share-text">Facebook</span></a> <a class="toolbar-share toolbar-email is-b" rel="nofollow" data-trigger=".social-share .toolbar-email"><span class="share-text">Email</span></a> <a class="toolbar-share toolbar-linkedin is-b" rel="nofollow" data-trigger=".social-share .toolbar-linkedin"><span class="share-text">LinkedIn</span></a> </div> </div> </li> <li class="toolbar-citation-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-citation is-b stats-citation" rel="nofollow" data-trigger=".abstract-toolbar .toolbar-citation"><span class="toolbar-link-text">Cite</span> <span class="toolbar-link-text-extra">This</span></a> </li> <li class="toolbar-permissions-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-permissions is-b" rel="nofollow" data-trigger=".abstract-toolbar .toolbar-permissions"><span class="toolbar-link-text">Permissions</span></a> </li> <li class="toolbar-comments-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-comments is-b" rel="nofollow" data-trigger=".abstract-toolbar .toolbar-comments"><span class="toolbar-link-text">Comment</span></a> </li> </ul> <div class="widget-ArticleTopInfo widget-instance-AMA_ArticleTop_Info_Widget"> <span class="hide tagmanagervalue" data-attribute="articleId" data-value="2781972" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="arrArticleAuthor" data-value="Christopher%20J.%C2%A0O%E2%80%99Donnell%2C%C2%A0MD%2C%20MPH,Lisa%C2%A0Schwartz%20Longacre%2C%C2%A0PhD,Beth%20E.%C2%A0Cohen%2C%C2%A0MD%2C%20MAS,Zahi%20A.%C2%A0Fayad%2C%C2%A0PhD,Charles%20F.%C2%A0Gillespie%2C%C2%A0MD%2C%20PhD,Israel%C2%A0Liberzon%2C%C2%A0MD,Gita%20A.%C2%A0Pathak%2C%C2%A0PhD,Renato%C2%A0Polimanti%2C%C2%A0PhD,Victoria%C2%A0Risbrough%2C%C2%A0PhD,Robert%20J.%C2%A0Ursano%2C%C2%A0MD,Richard%20S.%C2%A0Vander%20Heide%2C%C2%A0PhD,Clyde%20W.%C2%A0Yancy%2C%C2%A0MD%2C%20MSc,Viola%C2%A0Vaccarino%2C%C2%A0MD%2C%20PhD,George%C2%A0Sopko%2C%C2%A0MD,Murray%20B.%C2%A0Stein%2C%C2%A0MD%2C%20MPH" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="articleDOI" data-value="10.1001/jamacardio.2021.2530" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articleTitle" data-value="Posttraumatic Stress Disorder and Cardiovascular Disease<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>State of the Science, Knowledge Gaps, and Research Opportunities</span>" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="type" data-value="Special Communication" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueVolume" data-value="6" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueNo" data-value="10" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="publishDate" data-value="October 1, 2021" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="topics" data-value="Psychiatry and Behavioral Health, Trauma- and Stressor-Related Psychiatric Disorders, Cardiology, Genetics and Genomics, Research, Methods, Statistics" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="topicCode" data-value="5871, 42137, 5548, 5664, 5916" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="category" data-value="Review" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="journalClub" data-value="No" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentStatus" data-value="Locked" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articlePubState" data-value="Final" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentMedium" data-value="Article" data-type="string"></span> <div class="meta-article-type-wrap"> <div class="meta-article-type thm-col">Special Communication </div> </div> <div class="meta-date">July 14, 2021</div> <div class="meta-article-title-wrap"> <h1 class="meta-article-title ">Posttraumatic Stress Disorder and Cardiovascular Disease<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>State of the Science, Knowledge Gaps, and Research Opportunities</span></h1> </div> <div class="meta-authors"> <span class="meta-authors--limited"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Christopher+J.+O%e2%80%99Donnell&q=Christopher+J.+O%e2%80%99Donnell" rel=nofollow target="_blank">Christopher J. O’Donnell, MD, MPH<sup>1,2,3</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Lisa+Schwartz+Longacre&q=Lisa+Schwartz+Longacre" rel=nofollow target="_blank">Lisa Schwartz Longacre, PhD<sup>4</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Beth+E.+Cohen&q=Beth+E.+Cohen" rel=nofollow target="_blank">Beth E. Cohen, MD, MAS<sup>5</sup></a></span>; <a class="meta-authors--etal td-u stats-meta-authors--etal">et al</a></span> <span class="meta-authors--remaining"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Zahi+A.+Fayad&q=Zahi+A.+Fayad" rel=nofollow target="_blank">Zahi A. Fayad, PhD<sup>6,7</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Charles+F.+Gillespie&q=Charles+F.+Gillespie" rel=nofollow target="_blank">Charles F. Gillespie, MD, PhD<sup>8</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Israel+Liberzon&q=Israel+Liberzon" rel=nofollow target="_blank">Israel Liberzon, MD<sup>9</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Gita+A.+Pathak&q=Gita+A.+Pathak" rel=nofollow target="_blank">Gita A. Pathak, PhD<sup>10,11</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Renato+Polimanti&q=Renato+Polimanti" rel=nofollow target="_blank">Renato Polimanti, PhD<sup>10,11</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Victoria+Risbrough&q=Victoria+Risbrough" rel=nofollow target="_blank">Victoria Risbrough, PhD<sup>12,13</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Robert+J.+Ursano&q=Robert+J.+Ursano" rel=nofollow target="_blank">Robert J. Ursano, MD<sup>14</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Richard+S.+Vander+Heide&q=Richard+S.+Vander+Heide" rel=nofollow target="_blank">Richard S. Vander Heide, PhD<sup>15</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Clyde+W.+Yancy&q=Clyde+W.+Yancy" rel=nofollow target="_blank">Clyde W. Yancy, MD, MSc<sup>16,17</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Viola+Vaccarino&q=Viola+Vaccarino" rel=nofollow target="_blank">Viola Vaccarino, MD, PhD<sup>18</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=George+Sopko&q=George+Sopko" rel=nofollow target="_blank">George Sopko, MD<sup>4</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Murray+B.+Stein&q=Murray+B.+Stein" rel=nofollow target="_blank">Murray B. Stein, MD, MPH<sup>12,19,20</sup></a></span></span> </div> <div class="meta-author"> <a class="meta-author-title is-b stats-meta-author-toggle" data-tog-target=".meta-author-content">Author Affiliations</a> <a class="meta-articleinfo-jumplink section-jump-link scroll-to stats-scroll-to-articleinfo" data-tab-toggle=".tab-nav-full-text" href="#248040835">Article Information</a> <div class="meta-author-content"> <ul class="meta-author-affiliations"> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>1</sup>Cardiology Section, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>2</sup>Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>3</sup>Department of Medicine, Harvard Medical School, Boston, Massachusetts</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>4</sup>National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>5</sup>UCSF Department of Medicine, University of California, San Francisco</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>6</sup>Biomedical Engineering and Medical Institute, Icahn Mount Sinai School of Medicine, New York, New York</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>7</sup>Department of Cardiology, Icahn Mount Sinai School of Medicine, New York, New York</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>8</sup>Department of Psychiatry, Emory University, Atlanta, Georgia</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>9</sup>Department of Psychiatry, Texas A&M University, College Station</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>10</sup>Yale University School of Medicine, New Haven, Connecticut</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>11</sup>VA Connecticut Healthcare System, West Haven</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>12</sup>Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>13</sup>VA Center of Excellence for Stress and Mental Health, San Diego, California</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>14</sup>Department of Psychiatry, Uniformed Services University, Bethesda, Maryland</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>15</sup>Department of Pathology, Louisiana State University Health Science, New Orleans</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>16</sup>Department of Cardiology, Northwestern Medicine, Chicago, Illinois</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>17</sup>Deputy Editor, <i>JAMA Cardiology</i></div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>18</sup>Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>19</sup>Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>20</sup>VA San Diego Healthcare System, San Diego, California</div> </li> </ul> </div> </div> <div class="meta-citation-wrap"> <span class="meta-citation-journal-name">JAMA Cardiol. </span><span class="meta-citation"> 2021;6(10):1207-1216. doi:10.1001/jamacardio.2021.2530</span> </div> </div> <div class="widget-EditorsChoice widget-instance-AMA_EditorsChoice_Links"> </div> <div class="widget-LinkedContentToolbar widget-instance-AMA_LinkedContentToolbar"> <div class="linked-content-toolbar"> <div class="hidden js-search-open-multimedia-by-default" showContentByDefault="False"></div> <div class="linked-content-controls"> <a class="linked-content-trigger td-n stats-graphical-abstract" href="#graphical-abstract-tab"> <i class="icon-visual-abstract"><span class="sr-t">visual abstract icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Visual <div>Abstract</div></div> </a> <a class="linked-content-trigger td-n stats-editorial-comment" href="#editorial-comment-tab"> <i class="icon-document"><span class="sr-t">editorial comment icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Editorial <div>Comment</div></div> </a> <a class="linked-content-trigger td-n stats-related-articles" href="#related-articles-tab"> <i class="icon-related"><span class="sr-t">related articles icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Related <div>Articles</div></div> </a> <a class="linked-content-trigger td-n stats-author-interviews" href="#author-interviews-tab"> <i class="icon-author_interview"><span class="sr-t">author interview icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Interviews</div> </a> <a class="linked-content-trigger td-n stats-more-multimedia" href="#more-multimedia-tab"> <i class="icon-multimedia"><span class="sr-t">multimedia icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Multimedia</div> </a> <a class="linked-content-trigger td-n stats-listen-to-this-article" href="#listen-to-this-article-tab"> <i class="icon-audio"><span class="sr-t">audio icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Listen to <div>this article</div></div> </a> </div> <div class="linked-content-tabs"> <div id="graphical-abstract-tab" class="linked-content-tab graphical-abstract-tab"> <div class="widget-SectionDisplay widget-instance-AMA_GraphicalAbstract_Tab"> </div> </div> <div id="editorial-comment-tab" class="linked-content-tab editorial-comment-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_EditorialComments"> </div> </div> <div id="related-articles-tab" class="linked-content-tab related-article-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedArticle"> </div> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedEditorsChoices"> </div> </div> <div id="author-interviews-tab" class="linked-content-tab linked-author-interviews-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_AuthorInterviews"> <div class="audio-border-top thm-bg-col sb-background-pc"></div> <div class="audio-element-wrapper js-audio-element-wrapper"> <div class="audio-group-duration"> Podcast (20:44) </div> <div><a class="audio-title" href="https://jamanetwork.com/learning/audio-player/18625100" target="_blank" aria-label="Linked Multimedia Button">Posttraumatic Stress Disorder and Cardiovascular Disease</a></div> <div id="audio-player-wrapper" class="js-audio-player-wrapper audio-player-wrapper"> <audio class="js-audio-player" id="audio-player" type="audio/mp3" preload="none" src=https://traffic.libsyn.com/jamacardiologyauthorinterviews/posttraumatic_stress_disorder_and_cardiovascular_disease.mp3></audio> <div class="display-elements"> <div class="audio-controls"> <a id="backward" class="js-btn-backward audio-back" href="javascript:;" aria-label="Back Button"> <img src="//cdn.jamanetwork.com/UI/app/svg/multimedia/Backward_15.svg" alt="Backward 15" /> </a> <a id="play-pause" class="js-play-pause audio-play" href="javascript:;" aria-label="Play Button"> <img src="//cdn.jamanetwork.com/UI/app/svg/multimedia/Play.svg" alt="Play" /> </a> <a id="play-pause" class="js-play-pause audio-pause" href="javascript:;" aria-label="Pause Button"> <img src="//cdn.jamanetwork.com/UI/app/svg/multimedia/Pause.svg" alt="Pause" /> </a> <a id="forward" class="js-btn-forward audio-forward" href="javascript:;" aria-label="Fast Forward Button"> <img src="//cdn.jamanetwork.com/UI/app/svg/multimedia/Forward_15.svg" alt="Forward 15" /> </a> </div> <div class="js-progressBar-clickable progressBar-clickable"> <div class="js-progressBar progressBar"> <div class="js-loading-animation"> <div class="loading-blade thm-bg-col sb-pc"></div> <div class="loading-blade thm-bg-col sb-pc"></div> <div class="loading-blade thm-bg-col sb-pc"></div> <div class="loading-blade thm-bg-col sb-pc"></div> <div class="loading-blade thm-bg-col sb-pc"></div> <div class="loading-blade thm-bg-col sb-pc"></div> <div class="loading-blade thm-bg-col sb-pc"></div> <div class="loading-blade thm-bg-col sb-pc"></div> </div> <div class="js-timeBar timeBar thm-bg-col sb-background-pc" tabindex="0" aria-label="Progress Bar"></div> </div> </div> <div class="audio-speed"> <a id="speed-1x" class="js-btn-speed" play-speed=1 href="javascript:;" aria-label="Speed Control Button">1x</a> </div> <div class="audio-time"> <span id="time" class="js-time js-timeAudioCurrent">0:00</span> <span> / </span> <span class="js-initialTime">0:00</span> <span class="js-duration hide"></span> </div> </div> </div> <div class="linked-content-urls-wrapper"> <span><a class="thm-col sb-pc linked-content" target="_blank" href="https://jamanetwork.com/journals/jamacardiology/pages/jama-cardiology-author-interviews" aria-label="Subscribe To Podcast Button">Subscribe to Podcast</a></span> </div> </div> </div> <div class="widget-MultimediaInfo widget-instance-AMA_LinkedContentToolbar_AuthorInterviews"> </div> </div> <div id="listen-to-this-article-tab" class="linked-content-tab linked-listen-to-this-article-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_ListenToThisArticle"> </div> </div> <div id="more-multimedia-tab" class="linked-content-tab more-multimedia-tab"> <div class="widget-MultimediaInfo widget-instance-AMA_LinkedContentToolbar_MoreMultimedia"> </div> </div> </div> </div> </div> <a class="full-text-link is-b" data-url="" data-article-id="2781972"> <div class="full-text-link--text"><span class="full-text-link--text-top">Full </span>Text</div> </a> <div class="abstract-content"> <div class="widget-ArticleFulltext widget-instance-AMA_Article_Abstract_Widget"> <div class="article-full-text" data-userHasAccess="False"> <a class="article-section-id-anchor" id="248040797"></a> <div class="h3 cb section-type-abstract decorated-hed "> <div class="heading-text thm-col sb-sc"> Abstract </div> </div> <p class="para">Posttraumatic stress disorder (PTSD) is characterized by a persistent maladaptive reaction after exposure to severe psychological trauma. Traumatic events that may precipitate PTSD include violent personal assaults, natural and human-made disasters, and exposure to military combat or warfare. There is a growing body of evidence for associations of PTSD with major risk factors for cardiovascular disease (CVD), such as hypertension and diabetes, as well as with major CVD outcomes, such as myocardial infarction and heart failure. However, it is unclear whether these associations are causal or confounded. Furthermore, the biological and behavioral mechanisms underlying these associations are poorly understood. Here, the available evidence on the association of PTSD with CVD from population, basic, and genomic research as well as from clinical and translational research are reviewed, seeking to identify major research gaps, barriers, and opportunities in knowledge acquisition and technology as well as research tools to support and accelerate critical research for near-term and longer-term translational research directions. Large-scale, well-designed prospective studies, capturing diverse and high-risk populations, are warranted that include uniform phenotyping of PTSD as well as broad assessment of biological and behavioral risk factors and CVD outcomes. Available evidence from functional brain imaging studies demonstrates that PTSD pathophysiology includes changes in specific anatomical brain regions and circuits, and studies of immune system function in individuals with PTSD suggest its association with enhanced immune inflammatory activity. However, establishment of animal models and human tissue biobanks is also warranted to elucidate the potential causal connection of PTSD-induced brain changes and/or inflammation with CVD pathophysiology. Emerging large-scale genome-wide association studies of PTSD will provide an opportunity to conduct mendelian randomization studies that test hypotheses regarding the presence, magnitude, and direction of causal associations between PTSD and CVD outcomes. By identifying research gaps in epidemiology and genomics, animal, and human translational research, opportunities to better justify and design future interventional trials are highlighted that may test whether treatment of PTSD or underlying neurobiological or immune dysregulation may improve or prevent CVD risk or outcomes.</p> <div class="movable-ad-target bta"> </div> </div> </div> <div class="widget-ArticleLinks widget-instance-AMA_Abstract_EditorialComments"> </div> <a class="full-text-link is-b d-b bd-none ta-c fl-n radius mt1 mb1 m-auto" data-url="" data-article-id="2781972"> <div class="full-text-link--text fw-b"><span class="full-text-link--text-top">Full </span>Text</div> </a> <div class="seamless-access-button--mobile-only"> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_AdvancedSeamlessAccessButton_Mobile"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> </div> <div class="widget-UserComment widget-instance-AMA_Abstract_UserComment"> <div id="comment-wrapper"> <div class="comment-btn"> <a id="modal-opener" class="btn d-b mb1 sb-background-sc js-modal-opener" href="javascript:;">Comment</a> </div> </div> </div> <div class="widget-UserCommentBody widget-instance-AMA_UserCommentBody_Abstract"> </div> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_abstract_bta_dual"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_abstract_bta_dual" data-params="{"parameters":{"siteName":"jamacardiology","siteId":192,"journalId":184,"adDisplay":8,"adSection":"abstract","adPosition":"bta","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div class="widget-RelatedTopics widget-instance-AMA_Related_Topics_Abstract"> <div class="related-topics-block"> <h4 class="related-topics-heading topic-suggestions-heading sb-sc"> Read More About </h4> <div class="related-topics topic-suggestions"> <a href="https://jamanetwork.com/collections/5871/psychiatry-and-behavioral-health" id="item_Link" class="related-topic topic-suggestion no-wrap sb-anchor-light">Psychiatry and Behavioral Health</a> <a href="https://jamanetwork.com/collections/42137/trauma-and-stressor-related-psychiatric-disorders" id="item_Link_1" class="related-topic topic-suggestion no-wrap sb-anchor-light">Trauma- and Stressor-Related Psychiatric Disorders</a> <a href="https://jamanetwork.com/collections/5548/cardiology" id="item_Link_2" class="related-topic topic-suggestion no-wrap sb-anchor-light">Cardiology</a> <a href="https://jamanetwork.com/collections/5664/genetics-and-genomics" id="item_Link_3" class="related-topic topic-suggestion no-wrap sb-anchor-light">Genetics and Genomics</a> <a href="https://jamanetwork.com/collections/5916/research-methods-statistics" id="item_Link_4" class="related-topic topic-suggestion no-wrap sb-anchor-light">Research, Methods, Statistics</a> </div> </div> </div> </div> <div class="sidebar"> <div class="branded-bar"></div> <div class="abstract-toolbar"> <a id="pdf-link" href="/journals/jamacardiology/articlepdf/2781972/jamacardiology_odonnell_2021_sc_210001_1633734735.77532.pdf" class="toolbar-tool toolbar-pdf al-link pdfaccess js-pdfaccess" data-article-id="2781972" data-article-url="/journals/jamacardiology/articlepdf/2781972/jamacardiology_odonnell_2021_sc_210001_1633734735.77532.pdf" data-ajax-url="/Content/CheckPdfAccess"><span class="toolbar-pdf-text"><span class="toolbar-link-text-extra">Download </span><span class="toolbar-link-text">PDF</span></span> </a> <a class="toolbar-tool toolbar-full-text is-b" data-url="" data-article-id="2781972"><span class="toolbar-link-text-extra">Full</span> Text</a> <div class="widget-ToolboxGetCitation widget-instance-AMA_Get_Citation_Abstract"> <a class="toolbar-tool toolbar-citation is-b stats-citation" rel="nofollow" data-reveal-id="get-citation" data-reveal> <span class="toolbar-link-text">Cite</span> <span class="toolbar-link-text-extra">This</span> </a> <div id="get-citation" class="reveal-modal get-citation" data-reveal> <h3 class="get-citation-title">Citation</h3> <p class="get-citation-citation">O’Donnell CJ<span class='al-author-delim'>, </span>Schwartz Longacre L<span class='al-author-delim'>, </span>Cohen BE, et al. Posttraumatic Stress Disorder and Cardiovascular Disease<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>State of the Science, Knowledge Gaps, and Research Opportunities</span>. <em>JAMA Cardiol.</em> 2021;6(10):1207–1216. doi:10.1001/jamacardio.2021.2530</p> <h4 class="get-citation-download-heading">Manage citations:</h4> <div class="get-citation-types"> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2781972&resourceType=3&citationFormat=0">Ris (Zotero)</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2781972&resourceType=3&citationFormat=1">EndNote</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2781972&resourceType=3&citationFormat=2">BibTex</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2781972&resourceType=3&citationFormat=3">Medlars</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2781972&resourceType=3&citationFormat=0">ProCite</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2781972&resourceType=3&citationFormat=3">RefWorks</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2781972&resourceType=3&citationFormat=0">Reference Manager</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2781972&resourceType=3&citationFormat=0">Mendeley</a> </div> <p class="get-citation-copyright">© 2024 </p> <a class="close-reveal-modal icon-close" rel="nofollow"></a> </div> </div> <div class="widget-ToolboxPermissions widget-instance-AMA_Get_Permissions_Abstract"> <a href="http://s100.copyright.com/AppDispatchServlet?publisherName=AMA&publication=2380-6583&title=Posttraumatic+Stress+Disorder+and+Cardiovascular+Disease%3a+State+of+the+Science%2c+Knowledge+Gaps%2c+and+Research+Opportunities&publicationDate=2021-10-01&volumeNum=6&issueNum=10&author=O%e2%80%99Donnell%2c+Christopher+J.%3b+Schwartz+Longacre%2c+Lisa&startPage=1207&endPage=1216&contentId=10.1001%2fjamacardio.2021.2530&oa=&orderBeanReset=True" rel="nofollow" id="PermissionsLink" class="toolbar-tool toolbar-permissions is-b" target="_blank"><span class="toolbar-link-text">Permissions</span></a> </div> <a class="toolbar-tool toolbar-comments-jumplink toolbar-comments is-b" href="#modal-opener">Comment</a> </div> <div class="seamless-access-button--desktop-only"> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_AdvancedSeamlessAccessButton_Desktop"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> </div> <div class="widget-SignUpAffinityAlert widget-instance-AMAv2_AffinityAlertSignUp"> </div> <div class="cme-promo ta-c"> <div class="widget-SelfServeContent widget-instance-AMA_SelfServe_Promote_Cme_To_Inst_SubUsers"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="AMAV2_Rightrail_Other_Promo" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="bc_right_rail_article_promo"></div> <link rel="stylesheet" href="https://cdn.jamanetwork.com/data/CSSUploads/jamanetwork-selfserve-maintenance.css?versionId=82945"> <style type="text/css"> .jn-rr-feature {border-top: 4px solid #be1e32; border-bottom: 4px solid #be1e32;} p.globe-icon {font-weight:700;padding:0.35em 0} .icon-url:before {font-size:24px;margin-right:8px;} .icon-url:hover {text-decoration: none;} </style> <div class="jn-rr-feature"> <p class="globe-icon"><a href="/channels/ai" target="_blank"><span class="badge icon-url"></span>JAMA+ AI</a></p> </div>  <div class="bc_maintenance"></div> <iframe id="selfserve-maintenance" src="https://sites.jamanetwork.com/maintenance/index.html" width="100%" frameborder="0"></iframe>  </div> </div> </div> <div class="widget-WidgetLoader widget-instance-AMA_PersonalizedContent_AbstractView_RightRail"> <div class="SCM-SharedWidgets-AsyncWidgetLoader" data-url="/AMA/PersonalizedContent_RightRail/AMA_PersonalizedContent_AbstractView_RightRail" data-params="{"parameters":{"resourceIdToExclude":2781972,"resourceTypeToExclude":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_abstract_mid_dual"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_abstract_mid_dual" data-params="{"parameters":{"siteName":"jamacardiology","siteId":192,"journalId":184,"adDisplay":6,"adSection":"abstract","adPosition":"mid","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> <div class="widget-WidgetLoader widget-instance-AMA_JobsAd"> <div class="SCM-SharedWidgets-AsyncJobsAdLoader" data-url="/AMA/JobsAd/AMA_JobsAd" data-params="{"parameters":{"siteId":192},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> <h4 class="thm-col-sec">Others Also Liked</h4> <div id="trendmd-suggestions"></div> </div> </div> <div class="ymal--footer"> <div class="widget-WidgetLoader widget-instance-AMA_PersonalizedContent_AbstractView_Footer"> <div class="SCM-SharedWidgets-AsyncWidgetLoader" data-url="/Personalization/PersonalizedContent/AMA_PersonalizedContent_AbstractView_Footer" data-params="{"parameters":{"resourceIdToExclude":2781972,"resourceTypeToExclude":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div class="manage-interest"> <div class="widget-ManageCollectionInterests widget-instance-ManageCollectionInterests_Magazine"> <div class="manage-interests-modal reveal-modal small modal" data-reveal> <div class="manage-interests--header"> <div class="widget-SelfServeContent widget-instance-AMA_ManageInterests_Header"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="AllSitesManageInterestsHeader" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style> h4 { font-size: 20px !important; } </style> <h4>Select Your Interests</h4> <p>Customize your JAMA Network experience by selecting one or more topics from the list below.</p> </div> </div> </div><div class="manage-interests--categories"> <ul class="category-list"> <li><span class="category-list-item " data-categoryid="46425">Academic Medicine</span></li> <li><span class="category-list-item " data-categoryid="5489">Acid Base, Electrolytes, Fluids</span></li> <li><span class="category-list-item " data-categoryid="5504">Allergy and Clinical Immunology</span></li> <li><span class="category-list-item " data-categoryid="46447">American Indian or Alaska Natives</span></li> <li><span class="category-list-item " data-categoryid="5510">Anesthesiology</span></li> <li><span class="category-list-item " data-categoryid="42143">Anticoagulation</span></li> <li><span class="category-list-item " data-categoryid="6261">Art and Images in Psychiatry</span></li> <li><span class="category-list-item " data-categoryid="42097">Assisted Reproduction</span></li> <li><span class="category-list-item " data-categoryid="42099">Bleeding and Transfusion</span></li> <li><span class="category-list-item " data-categoryid="5548">Cardiology</span></li> <li><span class="category-list-item " data-categoryid="44036">Caring for the Critically Ill Patient</span></li> <li><span class="category-list-item " data-categoryid="6255">Challenges in Clinical Electrocardiography</span></li> <li><span class="category-list-item " data-categoryid="46435">Climate and Health</span></li> <li><span class="category-list-item " data-categoryid="46448">Climate Change</span></li> <li><span class="category-list-item " data-categoryid="44038">Clinical Challenge</span></li> <li><span class="category-list-item " data-categoryid="44039">Clinical Implications of Basic Neuroscience</span></li> <li><span class="category-list-item " data-categoryid="5614">Clinical Pharmacy and Pharmacology</span></li> <li><span class="category-list-item " data-categoryid="46499">Coaching</span></li> <li><span class="category-list-item " data-categoryid="5575">Complementary and Alternative Medicine</span></li> <li><span class="category-list-item " data-categoryid="44040">Consensus Statements</span></li> <li><span class="category-list-item " data-categoryid="46099">Coronavirus (COVID-19)</span></li> <li><span class="category-list-item " data-categoryid="5584">Critical Care Medicine</span></li> <li><span class="category-list-item " data-categoryid="46325">Cultural Competency</span></li> <li><span class="category-list-item " data-categoryid="44019">Dental Medicine</span></li> <li><span class="category-list-item " data-categoryid="5598">Dermatology</span></li> <li><span class="category-list-item " data-categoryid="44011">Diabetes and Endocrinology</span></li> <li><span class="category-list-item " data-categoryid="46320">Diagnostic Test Interpretation</span></li> <li><span class="category-list-item " data-categoryid="46498">Digital Health</span></li> <li><span class="category-list-item " data-categoryid="42054">Drug Development</span></li> <li><span class="category-list-item " data-categoryid="5621">Emergency Medicine</span></li> <li><span class="category-list-item " data-categoryid="5819">End of Life, Hospice, Palliative Care</span></li> <li><span class="category-list-item " data-categoryid="42107">Environmental Health</span></li> <li><span class="category-list-item " data-categoryid="46387">Equity, Diversity, and Inclusion</span></li> <li><span class="category-list-item " data-categoryid="42108">Ethics</span></li> <li><span class="category-list-item " data-categoryid="5644">Facial Plastic Surgery</span></li> <li><span class="category-list-item " data-categoryid="44012">Gastroenterology and Hepatology</span></li> <li><span class="category-list-item " data-categoryid="5664">Genetics and Genomics</span></li> <li><span class="category-list-item " data-categoryid="44041">Genomics and Precision Health</span></li> <li><span class="category-list-item " data-categoryid="5668">Geriatrics</span></li> <li><span class="category-list-item " data-categoryid="5670">Global Health</span></li> <li><span class="category-list-item " data-categoryid="46427">Guide to Statistics and Methods</span></li> <li><span class="category-list-item " data-categoryid="5672">Guidelines</span></li> <li><span class="category-list-item " data-categoryid="5674">Hair Disorders</span></li> <li><span class="category-list-item " data-categoryid="42113">Health Care Delivery Models</span></li> <li><span class="category-list-item " data-categoryid="42114">Health Care Economics, Insurance, Payment</span></li> <li><span class="category-list-item " data-categoryid="42116">Health Care Quality</span></li> <li><span class="category-list-item " data-categoryid="5680">Health Care Reform</span></li> <li><span class="category-list-item " data-categoryid="5830">Health Care Safety</span></li> <li><span class="category-list-item " data-categoryid="5682">Health Care Workforce</span></li> <li><span class="category-list-item " data-categoryid="5679">Health Disparities</span></li> <li><span class="category-list-item " data-categoryid="46328">Health Inequities</span></li> <li><span class="category-list-item " data-categoryid="44020">Health Policy</span></li> <li><span class="category-list-item " data-categoryid="46451">Health Systems Science</span></li> <li><span class="category-list-item " data-categoryid="5688">Hematology</span></li> <li><span class="category-list-item " data-categoryid="5692">History of Medicine</span></li> <li><span class="category-list-item " data-categoryid="5514">Humanities</span></li> <li><span class="category-list-item " data-categoryid="5697">Hypertension</span></li> <li><span class="category-list-item " data-categoryid="44043">Images in Neurology</span></li> <li><span class="category-list-item " data-categoryid="45887">Implementation Science</span></li> <li><span class="category-list-item " data-categoryid="5702">Infectious Diseases</span></li> <li><span class="category-list-item " data-categoryid="44044">Innovations in Health Care Delivery</span></li> <li><span class="category-list-item " data-categoryid="46477">JAMA Forum</span></li> <li><span class="category-list-item " data-categoryid="44070">JAMA Infographic</span></li> <li><span class="category-list-item " data-categoryid="5716">Law and Medicine</span></li> <li><span class="category-list-item " data-categoryid="45308">Leading Change</span></li> <li><span class="category-list-item " data-categoryid="44045">Less is More</span></li> <li><span class="category-list-item " data-categoryid="46327">LGBTQIA Medicine</span></li> <li><span class="category-list-item " data-categoryid="5720">Lifestyle Behaviors</span></li> <li><span class="category-list-item " data-categoryid="45311">Medical Coding</span></li> <li><span class="category-list-item " data-categoryid="5738">Medical Devices and Equipment</span></li> <li><span class="category-list-item " data-categoryid="44023">Medical Education</span></li> <li><span class="category-list-item " data-categoryid="5739">Medical Education and Training</span></li> <li><span class="category-list-item " data-categoryid="5713">Medical Journals and Publishing</span></li> <li><span class="category-list-item " data-categoryid="5746">Melanoma</span></li> <li><span class="category-list-item " data-categoryid="5766">Narrative Medicine</span></li> <li><span class="category-list-item " data-categoryid="5769">Nephrology</span></li> <li><span class="category-list-item " data-categoryid="5777">Neurology</span></li> <li><span class="category-list-item " data-categoryid="44052">Neuroscience and Psychiatry</span></li> <li><span class="category-list-item " data-categoryid="44053">Notable Notes</span></li> <li><span class="category-list-item " data-categoryid="5787">Nursing</span></li> <li><span class="category-list-item " data-categoryid="5788">Nutrition</span></li> <li><span class="category-list-item " data-categoryid="44027">Nutrition, Obesity, Exercise</span></li> <li><span class="category-list-item " data-categoryid="5791">Obesity</span></li> <li><span class="category-list-item " data-categoryid="44013">Obstetrics and Gynecology</span></li> <li><span class="category-list-item " data-categoryid="5796">Occupational Health</span></li> <li><span class="category-list-item " data-categoryid="5801">Oncology</span></li> <li><span class="category-list-item " data-categoryid="5804">Ophthalmology</span></li> <li><span class="category-list-item " data-categoryid="5808">Orthopedics</span></li> <li><span class="category-list-item " data-categoryid="5811">Otolaryngology</span></li> <li><span class="category-list-item " data-categoryid="44028">Pain Medicine</span></li> <li><span class="category-list-item " data-categoryid="46446">Palliative Care</span></li> <li><span class="category-list-item " data-categoryid="44029">Pathology and Laboratory Medicine</span></li> <li><span class="category-list-item " data-categoryid="45306">Patient Care</span></li> <li><span class="category-list-item " data-categoryid="6258">Patient Information</span></li> <li><span class="category-list-item " data-categoryid="5843">Pediatrics</span></li> <li><span class="category-list-item " data-categoryid="44060">Performance Improvement</span></li> <li><span class="category-list-item " data-categoryid="45315">Performance Measures</span></li> <li><span class="category-list-item " data-categoryid="42050">Perioperative Care and Consultation</span></li> <li><span class="category-list-item " data-categoryid="42125">Pharmacoeconomics</span></li> <li><span class="category-list-item " data-categoryid="42126">Pharmacoepidemiology</span></li> <li><span class="category-list-item " data-categoryid="5851">Pharmacogenetics</span></li> <li><span class="category-list-item " data-categoryid="44030">Pharmacy and Clinical Pharmacology</span></li> <li><span class="category-list-item " data-categoryid="5856">Physical Medicine and Rehabilitation</span></li> <li><span class="category-list-item " data-categoryid="42059">Physical Therapy</span></li> <li><span class="category-list-item " data-categoryid="45313">Physician Leadership</span></li> <li><span class="category-list-item " data-categoryid="44061">Poetry</span></li> <li><span class="category-list-item " data-categoryid="45316">Population Health</span></li> <li><span class="category-list-item " data-categoryid="46445">Primary Care</span></li> <li><span class="category-list-item " data-categoryid="45309">Professional Well-being</span></li> <li><span class="category-list-item " data-categoryid="44064">Professionalism</span></li> <li><span class="category-list-item " data-categoryid="5871">Psychiatry and Behavioral Health</span></li> <li><span class="category-list-item " data-categoryid="42128">Public Health</span></li> <li><span class="category-list-item " data-categoryid="5877">Pulmonary Medicine</span></li> <li><span class="category-list-item " data-categoryid="42129">Radiology</span></li> <li><span class="category-list-item " data-categoryid="42058">Regulatory Agencies</span></li> <li><span class="category-list-item " data-categoryid="46443">Reproductive Health</span></li> <li><span class="category-list-item " data-categoryid="5916">Research, Methods, Statistics</span></li> <li><span class="category-list-item " data-categoryid="42142">Resuscitation</span></li> <li><span class="category-list-item " data-categoryid="5896">Rheumatology</span></li> <li><span class="category-list-item " data-categoryid="46326">Risk Management</span></li> <li><span class="category-list-item " data-categoryid="38802">Scientific Discovery and the Future of Medicine</span></li> <li><span class="category-list-item " data-categoryid="46495">Sexual Health</span></li> <li><span class="category-list-item " data-categoryid="5833">Shared Decision Making and Communication</span></li> <li><span class="category-list-item " data-categoryid="5912">Sleep Medicine</span></li> <li><span class="category-list-item " data-categoryid="5915">Sports Medicine</span></li> <li><span class="category-list-item " data-categoryid="5533">Stem Cell Transplantation</span></li> <li><span class="category-list-item " data-categoryid="5921">Substance Use and Addiction Medicine</span></li> <li><span class="category-list-item " data-categoryid="5923">Surgery</span></li> <li><span class="category-list-item " data-categoryid="44065">Surgical Innovation</span></li> <li><span class="category-list-item " data-categoryid="44066">Surgical Pearls</span></li> <li><span class="category-list-item " data-categoryid="44067">Teachable Moment</span></li> <li><span class="category-list-item " data-categoryid="44034">The Art of JAMA</span></li> <li><span class="category-list-item " data-categoryid="44037">The Arts and Medicine</span></li> <li><span class="category-list-item " data-categoryid="6257">The Rational Clinical Examination</span></li> <li><span class="category-list-item " data-categoryid="5936">Tobacco and e-Cigarettes</span></li> <li><span class="category-list-item " data-categoryid="5938">Toxicology</span></li> <li><span class="category-list-item " data-categoryid="46433">Translational Medicine</span></li> <li><span class="category-list-item " data-categoryid="42136">Trauma and Injury</span></li> <li><span class="category-list-item " data-categoryid="5942">Treatment Adherence</span></li> <li><span class="category-list-item " data-categoryid="46323">Ultrasonography</span></li> <li><span class="category-list-item " data-categoryid="5947">Urology</span></li> <li><span class="category-list-item " data-categoryid="44069">Users' Guide to the Medical Literature</span></li> <li><span class="category-list-item " data-categoryid="5950">Vaccination</span></li> <li><span class="category-list-item " data-categoryid="5955">Venous Thromboembolism</span></li> <li><span class="category-list-item " data-categoryid="45312">Veterans Health</span></li> <li><span class="category-list-item " data-categoryid="5957">Violence</span></li> <li><span class="category-list-item " data-categoryid="42139">Women's Health</span></li> <li><span class="category-list-item " data-categoryid="45307">Workflow and Process</span></li> <li><span class="category-list-item " data-categoryid="42140">Wound Care, Infection, Healing</span></li> </ul> </div> <div class="manage-interests--save-preferences"> <div class="save-preferences-btn thm-bg "> <span class="save-preferences-btn-text fw-b">Save Preferences</span> </div> </div> <div class="manage-interests--privacy-terms"> <a class="manage-interests--privacy-terms-color" href="/pages/privacy-policy">Privacy Policy</a> | <a class="manage-interests--privacy-terms-color" href="/pages/terms-of-use">Terms of Use</a></div> <a class="close-reveal-modal icon-close"></a> </div> </div> </div> </section> <section id="secFooterControl" class="master-footer"> <script> var App = App || {}; function scmByClass(className) { return document.getElementsByClassName(className); } function scmById(id) { return document.getElementById(id); } function scmquery(selector) { return document.querySelector(selector); } function queryAll(selector) { return document.querySelectorAll(selector); } function isTrueString(string) { if (typeof string === 'string') { return string.toLowerCase() === 'true'; } return undefined; } function updateViewportDimensions() { var w = window, d = document, e = d.documentElement, g = d.getElementsByTagName('body')[0], x = w.innerWidth || e.clientWidth || g.clientWidth, y = w.innerHeight || e.clientHeight || g.clientHeight; return { width: x, height: y }; } var viewport = updateViewportDimensions(); var debounce = function (func, wait, immediate) { var timeout; return function () { var context = this, args = arguments; var later = function () { timeout = null; if (!immediate) func.apply(context, args); }; var callNow = immediate && !timeout; clearTimeout(timeout); timeout = setTimeout(later, wait); if (callNow) func.apply(context, args); }; }; (function (App) { App.mobileUpperBreakpoint = 767; App.mobileAltBreakpoint = 640; App.mobileMinBreakpoint = 547; App.tabletUpperBreakpoint = 1023; function setVariables() { viewport = updateViewportDimensions(); App.isMobile = (viewport.width <= App.mobileUpperBreakpoint); App.isMobileAlt = (viewport.width <= App.mobileAltBreakpoint); App.isTablet = (viewport.width > App.mobileUpperBreakpoint && viewport.width <= App.tabletUpperBreakpoint); App.isTabletDown = (viewport.width <= App.tabletUpperBreakpoint); App.isDesktop = (viewport.width > App.tabletUpperBreakpoint); App.activeViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large'; } setVariables(); App.cachedViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large'; App.isAnyArticle = !!(scmByClass('widget-ArticleFullView').length || scmByClass('pg_abstract').length || scmByClass('widget-MagazineView').length || scmByClass('widget-ChannelsMagazineView').length); App.isSplitScreen = !!scmByClass('widget-ArticleFullView').length; App.isArticleRedesign = !!scmByClass('widget-ArticleWrapper').length; App.isAbstract = !!scmByClass('pg_abstract').length; App.isMag = !!(scmByClass('widget-MagazineView').length); App.isChannel = !!(scmByClass('channel-site').length); App.isChannelMag = !!(scmByClass('widget-ChannelsMagazineView').length); App.isFreeArticle = !!(scmquery('.widget-ArticleTopInfo .free-access') || scmquery('.widget-ArticleTopInfo .open-access') || scmquery('.widget-ArticleTopInfo .icon-free') || scmquery('.widget-ChannelsMagazineView .free-access')); App.isTollFreeAccess = false; App.isIssue = !!scmByClass('pg_issue').length || !!scmByClass('pg_newonline').length || !!scmByClass('pg_currentissue').length || !!scmByClass('pg_pastissues').length; App.isNewOnline = !!scmByClass('pg_newonline').length; App.isCurrentIssue = !!scmByClass('pg_currentissue').length; App.isPastIssues = !!scmByClass('pg_pastissues').length; App.isJournal = !!scmByClass('pg_journal').length; App.isNetworkHome = !!scmByClass('pg_index').length; App.isSearch = !!scmByClass('pg_searchresults').length; App.isAdvancedSearch = !!scmByClass('pg_advancedsearch').length; App.isPlayer= !!scmByClass('pg_multimediaplayer').length; App.isSelfServe = !!scmByClass('pg_sspage').length; App.isCmsPage = !!scmByClass('pg_cmspage').length; App.isMyAccount = !!scmByClass('pg_myaccount').length; App.supportsFlexbox = !!scmByClass('flexbox').length; App.isCollection = !!scmByClass('pg_collection').length; App.isPaidUser = isTrueString(scmById('hfAppIsPaidUser').getAttribute('value')); App.isMember = isTrueString(scmById('hfAppIsMember').getAttribute('value')); App.isIndividual = isTrueString(scmById('hfAppIsIndividual').getAttribute('value')); App.hasAccess = isTrueString(scmById('hfAppHasAccess').getAttribute('value')); App.isReferredFromGoogle = isTrueString(scmById('hfAppIsReferredFromGoogle').getAttribute('value')); var subscribedTo = scmById('hfAppSubscribedTo').getAttribute('value'); App.userSubscribedTo = subscribedTo ? subscribedTo.split(',') : undefined; App.isLucy = isTrueString(scmById('hfAppIsLucy').getAttribute('value')); App.currentJournalCount = 27; App.isChannelPage = !!(scmByClass('channels-page')); App.updateAppVariables = debounce(function () { setVariables(); }, 50, false); })(App); </script> <div class="footer-ad-wrapper"> <div id="BodyContent_Footer_divAds" class="footer-ad desktop-only"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_AnchorboardAd_btf"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_AnchorboardAd_btf" data-params="{"parameters":{"siteName":"jamacardiology","siteId":192,"journalId":184,"adDisplay":11,"adSection":"abstract","adPosition":"btf","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> </div> <div class="ad-riser-wrap desktop-only"> <div class="ad-riser--dismiss t-c">X</div> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_Riser"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_Riser" data-params="{"parameters":{"siteName":"jamacardiology","siteId":192,"journalId":184,"adDisplay":12,"adSection":"abstract","adPosition":"Riser","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div class="footer-wrap"> <footer class="footer" id="footer"> <div id="footer-microsite" class="footer-microsite"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Left" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> @media (min-width: 1024px) {.split-screen .footer-microsite-contents {border-bottom:0 !important;}} .footer-microsite-contents {margin-bottom:1em;width:100%;} .footer-network-other .link-apps:before {width: 23px;} .footer-network-other .link-institutions-librarians:before {width: 23px;} .jn-ss-footer-border-top {border-top:1px solid #555;padding-top:15px;} .jn-ss-footer-border-bottom {border-bottom:1px solid #555;padding-bottom:10px;padding-right:5px;} </style> <div class="footer-heading-wrap"> <h3 id="BodyContent_Footer_h3SiteName" class="footer-heading is-b footer-microsite-heading" data-mobile-tog-target=".footer-microsite-links-wrap">JAMA Cardiology</h3> </div> <div class="footer-microsite-links-wrap"> <div class="footer-microsite-contents jn-ss-footer-border-bottom"> <h4 id="BodyContent_Footer_ContentHeader" class="footer-subheading">Content</h4> <a href="/journals/jamacardiology">Home</a> <a href="/journals/jamacardiology/newonline">New Online</a> <a href="/journals/jamacardiology/currentissue">Current Issue</a> </div> <div class="footer-microsite-contents jn-ss-footer-border-bottom"> <h4 class="footer-subheading">Podcast</h4> <a href="/journals/jamacardiology/pages/jama-cardiology-author-interviews">JAMA Cardiology Author Interviews</a> </div> <div class="footer-microsite-services cf"> <h4 id="BodyContent_Footer_ServiceHeader" class="footer-subheading">Journal Information</h4> <a href="/journals/jamacardiology/pages/for-authors">For Authors</a> <a href="/journals/jamacardiology/editors-and-publishers">Editors & Publishers</a> <a href="/pages/rss">RSS</a> <a href="/journals/jamacardiology/pages/contact-us">Contact Us</a> </div> <div class="footer-network-other jn-ss-footer-border-bottom"> <a href="https://edhub.ama-assn.org/jn-learning" class="link-network-other is-b link-learning">JN Learning / CME</a> <a href="https://store.jamanetwork.com" class="link-network-other is-b link-store" target="_blank">Store</a> <a href="/pages/apps" class="link-network-other is-b link-mobile" target="_blank">Apps</a> <a href="https://careers.jamanetwork.com/" class="link-network-other is-b link-jobs" target="_blank">Jobs</a> <a href="/pages/resources-for-librarians" class="link-network-other is-b link-institutions-librarians" target="_blank">Institutions</a> <a href="/pages/reprints-and-permissions" class="link-network-other is-b link-reprints-permissions">Reprints & Permissions</a> </div> <div id="BodyContent_Footer_divSubscribe" class="footer-microsite-subscribe"> <img src="//cdn.jamanetwork.com/UI/app/img/covers/cardi.jpg" class="subscribe-image" alt="Journal Cover"> <div class="subscribe-meta"> <h4 class="subscribe-heading footer-subheading">Subscribe</h4> <a href="https://store.jamanetwork.com/productDetails.aspx?productcodeID=180" class="subscribe-submit btn">Go</a> </div> </div> </div> </div> <div id="footer-network" class="footer-network"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Middle" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-network-sites {width: 62.85542%;} .footer-network-info {width: 35.93976%} .jn-ss-subheading-mt {margin-top: 1.5em;} .jn-registered:after {content: "\00AE";font-size: 50%;vertical-align: top;} .jn-trademark:after {content: "\2122";font-size: 50%;vertical-align: top;} .nav-logo-cme-signin-container .nav-logo .site-logo img { min-width:50px;} </style> <div class="footer-heading-wrap"> <h3 class="footer-heading is-b jn-registered" data-mobile-tog-target=".footer-network-links-wrap"><strong>JAMA</strong> Network</h3> </div> <div class="footer-network-links-wrap"> <div class="footer-network-sites"> <div class="internal"> <h4 id="BodyContent_Footer_JournalHeader" class="footer-subheading">Publications</h4> <a href="/journals/jama">JAMA</a> <a href="/journals/jamanetworkopen" target="_blank">JAMA Network Open</a> <a href="/journals/jamacardiology">JAMA Cardiology</a> <a href="/journals/jamadermatology">JAMA Dermatology</a> <a href="/journals/jama-health-forum">JAMA Health Forum</a> <a href="/journals/jamainternalmedicine">JAMA Internal Medicine</a> <a href="/journals/jamaneurology">JAMA Neurology</a> <a href="/journals/jamaoncology">JAMA Oncology</a> <a href="/journals/jamaophthalmology">JAMA Ophthalmology</a> <a href="/journals/jamaotolaryngology">JAMA Otolaryngology–Head & Neck Surgery</a> <a href="/journals/jamapediatrics">JAMA Pediatrics</a> <a href="/journals/jamapsychiatry">JAMA Psychiatry</a> <a href="/journals/jamasurgery">JAMA Surgery</a> <a href="/journals/archneurpsyc">Archives of Neurology & Psychiatry (1919-1959)</a> </div> <div class="external"> <h4 class="footer-subheading">Sites</h4> <div id="BodyContent_Footer_ssFooterSiteMenu"> <div class="selfServe"> <a target="_blank" href="https://sites.jamanetwork.com/art-and-images-in-psychiatry/">Art and Images in Psychiatry</a> <a target="_blank" href="/journals/jama/pages/2023-most-viewed-jama">Best of the JAMA Network</a> <a target="_blank" href="/channels/caring-for-the-critically-ill-patient">Caring for the Critically Ill Patient</a> <a target="_blank" href="/journals/jama/pages/crosswords">Clinical Crosswords from JAMA</a> <a target="_blank" href="/journals/jama/pages/coronavirus-alert">Coronavirus Resource Center</a> <a target="_blank" href="https://ebm.jamanetwork.com/index.html">Evidence-Based Medicine: An Oral History</a> <a target="_blank" href="/pages/fishbein-fellowship">Fishbein Fellowship</a> <a target="_blank" href="/channels/genomics/">Genomics and Precision Health</a> <a target="_blank" href="/pages/health-and-the-2024-us-election">Health and the 2024 US Election</a> <a target="_blank" href="/channels/hypertension">Hypertension</a> <a target="_blank" href="/channels/health-forum/archive">JAMA Forum Archive</a> <a target="_blank" href="https://sites.jamanetwork.com/audio">JAMA Network Audio</a> <a target="_blank" href="/pages/video">JAMA Network Video</a> <a target="_blank" href="/pages/conferences">JAMA Network Conferences </a> <a target="_blank" href="/channels/ai">JAMA+ AI</a> <a target="_blank" href="/pages/jama-summit">JAMA Summit </a> <a target="_blank" href="/journals/jamasurgery/pages/statistics-and-methods">JAMA Surgery Guide to Statistics and Methods</a> <a target="_blank" href="/channels/medical-news">Medical News</a> <a target="_blank" href="/channels/monkeypox">Mpox (Monkeypox)</a> <a target="_blank" href="https://sites.jamanetwork.com/research-ethics/">Research Ethics</a> <a target="_blank" href="/pages/collections">Topics and Collections</a> <a target="_blank" href="/pages/visual-abstracts">Visual Abstracts</a> <a target="_blank" href="/channels/war">War and Health</a> <a target="_blank" href="/channels/womens-health">Women's Health</a> <h4 class="footer-subheading jn-ss-subheading-mt">Featured Articles</h4> <a href="/journals/jama/fullarticle/2781397">CONSERVE 2021 Guidelines for Reporting Trials Modified for the COVID-19 Pandemic</a> <a href="/journals/jama/fullarticle/2808296">Creation and Adoption of Large Language Models in Medicine</a> <a href="/journals/jamaoncology/fullarticle/2787350">Global Burden of Cancer, 2010-2019</a> <a href="/journals/jama/fullarticle/2797443">Global Burden of Long COVID</a> <a href="/journals/jamadermatology/fullarticle/2790344">Global Burden of Melanoma</a> <a href="/journals/jamadermatology/fullarticle/2787350">Global Burden of Skin Diseases, 1990-2017</a> <a href="/journals/jamaneurology/fullarticle/2793874">Global Disparities in Parkinson Disease</a> <a href="/journals/jama/fullarticle/2799547">Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension</a> <a href="/journals/jamapsychiatry/fullarticle/2799486">Mass Violence and the Complex Spectrum of Mental Illness and Mental Functioning</a> <a href="/journals/jamapsychiatry/fullarticle/2793903">Neuropsychiatry Sequelae of COVID-19</a> <a href="/journals/jamaneurology/fullarticle/2810313">A New Framework for Dementia Nomenclature</a> <a href="/journals/jama/fullarticle/2800656">Organization and Performance of US Health Systems</a> <a href="/journals/jama-health-forum/fullarticle/2791195">Pharmacy Benefit Managers: History, Business Practices, Economics, and Policy</a> <a href="/journals/jama-health-forum/fullarticle/2791195">Promoting EDI in Genetics Research</a> <a href="/journals/jamacardiology/fullarticle/2781972">PTSD and Cardiovascular Disease</a> <a href="/journals/jama/fullarticle/2810754">Red Blood Cell Transfusion: 2023 AABB International Guidelines</a> <a href="/journals/jamapediatrics/fullarticle/2797600">Reimagining Children’s Rights in the US</a> <a href="/journals/jama/fullarticle/2794049">Spirituality in Serious Illness and Health</a> <a href="/journals/jama/fullarticle/2796374">The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity</a> <h4 class="footer-subheading jn-ss-subheading-mt">USPSTF Recommendation Statements</h4> <a href="/journals/jama/fullarticle/2779985">Screening for Colorectal Cancer</a> <a href="/journals/jama/fullarticle/2779190">Screening for Hypertension</a> <a href="/journals/jama/fullarticle/2777244">Screening for Lung Cancer</a> <a href="/journals/jama/fullarticle/2796244">Screening for Prediabetes and Type 2 Diabetes In Children</a> <a href="/journals/jama/fullarticle/2783414">Screening for Prediabetes and Type 2 Diabetes In Adults</a> <a href="/journals/jama/fullarticle/2795521">Statins for Primary Prevention of Cardiovascular Disease</a> <a href="/journals/jama/fullarticle/2793446">Vitamin and Mineral Supplements for Primary Prevention of of Cardiovascular Disease and Cancer</a> <h4 class="footer-subheading jn-ss-subheading-mt">Blogs</h4> <a target="_blank" href="https://amastyleinsider.com/">AMA Style Insider</a> </div> </div> </div> </div> <div id="footer-network-info" class="footer-network-info"> <div class="information-for-links"> <h4 id="BodyContent_Footer_InfoHeader" class="footer-subheading">Information</h4> <a href="/pages/for-authors">For Authors</a> <a href="/pages/resources-for-librarians">For Institutions & Librarians</a> <a href="/pages/advertisers">For Advertisers</a> <a href="/pages/subscription-agents">For Subscription Agents</a> <a href="https://careers.jamanetwork.com/" target="_blank">For Employers & Job Seekers</a> <a href="https://media.jamanetwork.com" rel="nofollow" target="_blank">For the Media</a> <a href="/pages/equity-diversity-inclusion">Equity, Diversity, Inclusion</a> <a href="/pages/commenting-policy">Online Commenting Policy</a> <a href="/pages/access-at-jama-network">Public Access and Open Access Policy</a> <a href="/pages/offensive-content-statement">Statement on Potentially Offensive Content</a> </div> <div class="services-links"> <h4 id="BodyContent_Footer_JAMANetworkProductsHeader" class="footer-subheading">JAMA Network Products</h4> <a href="http://www.amamanualofstyle.com/" class="footer-service-link" target="_blank">AMA Manual of Style</a> <a href="https://jamaevidence.mhmedical.com/" class="footer-service-link" target="_blank"><span class="jn-registered">JAMAevidence</span></a> <a href="http://www.peerreviewcongress.org/" class="footer-service-link" target="_blank">Peer Review Congress</a> </div> <div class="learning-links"> <h4 id="BodyContent_Footer_LearningHeader" class="footer-subheading">JN Learning</h4> <a href="https://edhub.ama-assn.org/jn-learning">Home</a> <a href="https://edhub.ama-assn.org/jn-learning/state-cme">State CME</a> <a href="https://edhub.ama-assn.org/jn-learning/pages/clinical-challenge-courses">Clinical Challenge CME</a> <a href="https://edhub.ama-assn.org/jn-learning/course/288 ">Atrial Fibrillation Course</a> <a href="https://edhub.ama-assn.org/jn-learning/course/294 ">Women's Health Course</a> <a target="_blank" href="https://edhub.ama-assn.org/pages/auto-credit-reporting">CME / MOC Reporting Preferences</a> <a href="https://edhub.ama-assn.org/jn-learning/pages/about-cme">About CME & MOC</a> </div> </div> </div> </div> <div id="footer-resources-wrap" class="footer-resources-wrap"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Right" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-resources-wrap .footer-subheading {color: grey;display:block !important;font-size: 1.17647em;font-weight: 400;text-transform: uppercase;} </style> <div class="footer-heading-wrap"> <h3 class="footer-heading is-b footer-resources-heading" data-mobile-tog-target=".footer-resources">Help</h3> </div> <div class="footer-resources"> <a href="https://store.jamanetwork.com" class="footer-service-link" target="_blank">Subscriptions & Renewals</a> <a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-alerts" class="footer-service-link" rel="nofollow">Manage Emails</a> <a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-profile" class="footer-service-link" rel="nofollow">Update My Address</a> <a href="https://support.jamanetwork.com/hc/en-us" class="footer-service-link">Support Center</a> <a href="/myaccount " class="footer-service-link">My Account</a> <h4 class="footer-subheading jn-ss-subheading-mt">JAMA Career Center</h4> <a href="https://careers.jamanetwork.com/" class="footer-service-link" target="_blank">Physician Job Listings</a> </div> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Socials" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .widget-instance-AMA_Journal_Home_Socials .iconsocial {display: inline-block !important;width: 34px;height: 34px;min-width: unset !important;margin: 0 2px !important;background-color: #fff;border-radius: 20px;border: 1px solid #191919;vertical-align: middle;} .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);background-position: 7px 7px;background-repeat: no-repeat;background-size: 18px;} .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:hover, .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:focus {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png);border-color: #C13584;} .footer-resources-wrap .iconsocial {display: inline-block !important;width: 32px;height: 32px;min-width: unset !important;margin: 0 2px 0 3px !important;background-color: #fff;border-radius: 20px;border: 1px solid #191919;vertical-align: middle;} .footer-resources-wrap .iconsocial.instagram {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);background-position: 6px 6px;background-repeat: no-repeat;background-size: 18px;} .footer-resources-wrap .iconsocial.instagram:hover, .footer-resources-wrap .iconsocial.instagram:focus {background-color: #C13584;border-color: #191919;} #load-instagram-image { background: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png) no-repeat -9999px -9999px; } </style> <div id="BodyContent_Footer_divSocial" class="social-links footer-social-links"> <a target="_blank" rel="nofollow" data-emailid="4b90b9f5-52f7-4e1c-8277-26d8e88df658" href="https://www.facebook.com/JAMACardiology" class="social-link is-b facebook"></a> <a target="_blank" rel="nofollow" data-emailid="4b90b9f5-52f7-4e1c-8277-26d8e88df658" href="https://twitter.com/jamacardio" class="social-link is-b twitter"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.instagram.com/jamanetwork/?hl=en" class="iconsocial instagram"></a> <a target="_blank" rel="nofollow" data-emailid="4b90b9f5-52f7-4e1c-8277-26d8e88df658" href="https://www.linkedin.com/showcase/jamacardiology/" class="social-link is-b linked-in"></a> <a target="_blank" rel="nofollow" data-emailid="4b90b9f5-52f7-4e1c-8277-26d8e88df658" href="https://ja.ma/caryt" class="social-link is-b you-tube"></a> <a target="_blank" rel="nofollow" data-emailid="4b90b9f5-52f7-4e1c-8277-26d8e88df658" href="https://www.pinterest.com/jamanetwork/" class="social-link is-b pinterest"></a> <a target="_blank" rel="nofollow" data-emailid="4b90b9f5-52f7-4e1c-8277-26d8e88df658" href="/rss/site_192/184.xml" class="social-link is-b rss"></a> <a target="_blank" rel="nofollow" data-emailid="4b90b9f5-52f7-4e1c-8277-26d8e88df658" href="https://jamanetwork.com/journals/jamacardiology/pages/jama-cardiology-author-interviews" class="social-link is-b podcast"></a> <div id="load-instagram-image"></div> </div> <div id="BodyContent_Footer_divEmailUpdate" class="footer-email-updates"> <div class="widget-EmailListSignUp widget-instance-AMAv2_EmailListSignUp_Footer"> <div class="email-signup"> <div class="email-signup--text sb-pc">Get the latest from JAMA Cardiology</div> <div class="email-signup--input-wrap is-b"> <input type="text" name="email" class="email-signup--input" placeholder="Email address" title="Email address" /> <a rel="nofollow" href="javascript:;" class="email-signup--submit sb-sc btn">Sign Up</a> </div> <div class="email-signup--link"> <a class="email-signup--privacy" href="/pages/privacy-policy">Privacy Policy</a> | <a class="email-signup--terms" href="/pages/terms-of-use">Terms of Use</a></div> <div class="email-signup--user-message"></div> </div> </div> </div> </div> <div class="footer-bar" itemscope itemtype="https://schema.org/Organization"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Bottom_Bar" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .network-bar .auth--inst {color:#B8B8B8;} .multimedia-caption-container div.video-caption {color: #262626;font-size: 15px;font-weight: 700;line-height: 1.5;} .nav-journals a.theme-jama-health-forum:before {background: #133763;} .jn-bottom-bar {color: #fff; float: left;font-size: 10px;padding: 13px 20px;width: 33.33%;} .jn-bottom-bar p {line-height: 2;} @media (max-width: 900px) {.jn-bottom-bar {float: none;width: 100%;}} .jn-footer-copyright {font-size:12px;line-height:1.5;margin-bottom:10px;} .jn-footer-pipe {margin:0 10px;} .footer-bar-jn-logo img {width: 230px;} @media (max-width: 900px) {.footer-bar-jn-logo img {width: 200px;}} [data-thm=umb] .jobs-ad--text h6 {color: #d71635 !important;} [data-thm=jama] .jobs-ad--text h6 {color: #d71635 !important;} [data-thm=jaman] .jobs-ad--text h6 {color: #ed0973 !important;} [data-thm=cardi] .jobs-ad--text h6 {color: #be1e32 !important;} [data-thm=derm] .jobs-ad--text h6 {color: #006f3b !important;} [data-thm=faci] .jobs-ad--text h6 {color: #ed1c24 !important;} [data-thm=jama-] .jobs-ad--text h6 {color: #fb5252 !important;} [data-thm=intem] .jobs-ad--text h6 {color: #006e96 !important;} [data-thm=neur] .jobs-ad--text h6 {color: #981b1e !important;} [data-thm=oncol] .jobs-ad--text h6 {color: #3b923f !important;} [data-thm=ophth] .jobs-ad--text h6 {color: #66bc29 !important;} [data-thm=otol] .jobs-ad--text h6 {color: #34b6e4 !important;} [data-thm=peds] .jobs-ad--text h6 {color: #0084c0 !important;} [data-thm=psych] .jobs-ad--text h6 {color: #005276 !important;} [data-thm=surg] .jobs-ad--text h6 {color: #f47920 !important;} .blockquote .para {margin: 0 0 1em 1em;} .jn-footer-copyright {display: block;} .inline-block {display: inline-block;} </style> <a class="footer-bar-jn-logo d-b no-mw mb1" href="/" title="JAMA Network Home"><img class="mw-100" src="https://cdn.jamanetwork.com/ImageLibrary/global/jn-signature-reversed-r.svg?versionId=82308" alt="Jama Network Logo"></a> <div class="jn-bottom-bar"> <p> <span class="jn-footer-copyright">© 2024 American Medical Association. <span class="inline-block">All rights reserved,</span> including those for text and data mining, AI training, <span class="inline-block">and similar technologies.</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/terms-use" rel="nofollow" class="p0">Terms of Use</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/privacy-policy" rel="nofollow" class="p0">Privacy Policy</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/accessibility-statement" rel="nofollow" class="p0">Accessibility Statement</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a onclick="OneTrust.ToggleInfoDisplay()" rel="nofollow" class="p0" id="CookieFooter">Cookie Settings</a></span> </p> </div>  <a class="footer-bar-sis no-mw relative nudge-down" href="https://www.silverchair.com" target="_blank"><img class="footer-bar-sis-img mt05 mw-100" width="600" height="70" src="//cdn.jamanetwork.com/UI/app/img/powered.png" alt="Silverchair Logo" /></a> </div> </footer> </div> <div class="ss-ui-only"> <div class="widget-SelfServeContent widget-instance-AMA_SS_UI_Only"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SsUiOnly" /> <input type="hidden" class="SelfServeVersionId" value="0" /> . </div> </div> </div> </section> <div id="revealModal" class="reveal-modal" data-reveal> <div id="revealContent"></div> <a class="close-reveal-modal icon-close"></a> </div> <div class="artmet-modal" id="MetricsModal"> <div class="artmet-modal-contents"> <a class="artmet-close-modal">×</a> </div> </div> <div class="widget-SigninModals widget-instance-AMA_SigninModals"> <div class="js-modal-no-access-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Access your subscriptions</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_NoAccess_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_PurchaseOptions_NoAccessAndPaidPDF"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_NoAccessAndPaidPDF" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr> <button class="modal--btn js-btn-subscribe-journal" type="button" role="button"> <div class="text-truncate">Subscribe to journal</div> </button> <div class="modal--btn-desc">Get full journal access for 1 year</div> <button class="modal--btn js-btn-purchase-article" type="button" role="button"> <div class="text-truncate">Buy article</div> </button> <div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br> <em>Sign in or create a free account</em></div>  </div> </div> <div class="widget-DeepDyve widget-instance-AMA_NoAccess_DeepDyve"> <button type="button" role="button" class="modal--btn js-deepdyve-link hiddenRentalLink" data-deepdyveurl="https://www.deepdyve.com/doc-view?docId=10.1001/jamacardio.2021.2530&fieldName=journal_doi&affiliateId=JAMA" data-doi="10.1001/jamacardio.2021.2530" data-fieldname="journal_doi" data-issneissn="2380-6583" data-affiliate="JAMA">Rent article</button> <div class="modal--btn-desc js-deepdyve-desc hiddenRentalLink">Rent this article from DeepDyve</div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-paid-pdf-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Access your subscriptions</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_PaidPdf_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_PurchaseOptions_NoAccessAndPaidPDF"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_NoAccessAndPaidPDF" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr> <button class="modal--btn js-btn-subscribe-journal" type="button" role="button"> <div class="text-truncate">Subscribe to journal</div> </button> <div class="modal--btn-desc">Get full journal access for 1 year</div> <button class="modal--btn js-btn-purchase-article" type="button" role="button"> <div class="text-truncate">Buy article</div> </button> <div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br> <em>Sign in or create a free account</em></div>  </div> </div> <div class="widget-DeepDyve widget-instance-AMA_PaidPDF_DeepDyve"> <button type="button" role="button" class="modal--btn js-deepdyve-link hiddenRentalLink" data-deepdyveurl="https://www.deepdyve.com/doc-view?docId=10.1001/jamacardio.2021.2530&fieldName=journal_doi&affiliateId=JAMA" data-doi="10.1001/jamacardio.2021.2530" data-fieldname="journal_doi" data-issneissn="2380-6583" data-affiliate="JAMA">Rent article</button> <div class="modal--btn-desc js-deepdyve-desc hiddenRentalLink">Rent this article from DeepDyve</div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-free-pdf-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Sign in to access free PDF</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_FreePdf_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_FreePdf_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-save-search-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Save your search</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_SaveSearch_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_SaveSearch"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_SaveSearch" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr /> <button class="modal--btn js-btn-subscribe-now">Subscribe now</button>  </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-follow-collection-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Customize your interests</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_FollowCollection_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_FollowCollection"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_FollowCollection" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--sub-title">Create a personal account or sign in to:</div> <ul> <li>Register for email alerts with links to free full-text articles</li> <li>Access PDFs of free articles</li> <li>Manage your interests</li> <li>Save searches and receive search alerts</li> <ul>  </div> </div> <div class="modal--link-wrap"> <a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-user-comment-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Make a comment</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjamacardiology%2ffullarticle%2f2781972"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_UserComment_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_UserComment"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_UserComment" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--sub-title">Create a personal account or sign in to:</div> <ul> <li>Register for email alerts with links to free full-text articles</li> <li>Access PDFs of free articles</li> <li>Manage your interests</li> <li>Save searches and receive search alerts</li> <ul>  </div> </div> <div class="modal--link-wrap"> <a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="hidden-true js-modal-page-data" data-store-url="https://store.jamanetwork.com" data-store-purchase-url="https://jamanetwork.com/oauthsignin?return_url=https://store.jamanetwork.com" data-store-subscribe-url="https://store.jamanetwork.com/index.aspx?productcode=180"> </div> </div> <script src="//cdn.jamanetwork.com/UI/app/vendor/jquery-2.2.4.min.js?v=638654734634555810"></script> <script>window.jQuery || document.write('<script src="/UI/app/vendor/jquery-2.2.4.min.js">\x3C/script>')</script> <script src="//cdn.jamanetwork.com/UI/app/dist/app.min.js?v=638677764559592887" defer></script> <script src="//cdn.jsdelivr.net/chartist.js/latest/chartist.min.js" type="text/javascript"></script> <script src="//d1bxh8uas1mnw7.cloudfront.net/assets/embed.js" type="text/javascript"></script> <script defer src='//js.trendmd.com/trendmd.min.js' data-trendmdconfig='{"element":"#trendmd-suggestions"}'></script> <script type='text/javascript' src='https://platform-api.sharethis.com/js/sharethis.js#property=643701de45aa460012e1032e&product=sop' async='async'></script> </form> <link rel="stylesheet" href="//cdn.jamanetwork.com/UI/app/scss/modules/_trendMD.css"> <div class="widget-CustomJSScript widget-instance-"> <script src="//cdn.jamanetwork.com/ama/ama.proxylogging.js" async></script> </div> </body> </html>

CINXE.COM

Posttraumatic Stress Disorder and Cardiovascular Disease: State of the Science, Knowledge Gaps, and Research Opportunities | Psychiatry and Behavioral Health | JAMA Cardiology | JAMA Network