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Circ Cardiovasc Qual Outcomes. 2018 Jul;11(7):e004572. doi: 10.1161/CIRCOUTCOMES.117.004572.

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.

Author information

Barry Commoner Center for Health and the Environment, Queens College, City University of New York (M.R., Z.L., A.M.).
University of North Carolina Gillings School Of Global Public Health, Chapel Hill (M.R.).
University of Michigan School of Public Health, Epidemiology, Ann Arbor (Z.L.).
James J. Peters Veterans Affairs Medical Center, Bronx, NY (J.F.).
Department of Psychiatry, Icahn Mount Sinai School of Medicine, NY (J.F.).
Department of Epidemiology, Mailman School of Public Health, Columbia University, NY (C.M.-M., A.M.).
Barry Commoner Center for Health and the Environment, Queens College, City University of New York (M.R., Z.L., A.M.).



We sought to determine whether post-traumatic stress disorder (PTSD) is a risk factor for myocardial infarction (MI) and stroke, beyond the expected effects from recognized cardiovascular risk factors and depression.


World Trade Center-Heart is an observational prospective cohort study of 6481 blue-collar first responders nested within the World Trade Center Health Program in New York City. Baseline measures in 2012 and 2013 included blood pressure, weight and height, and blood lipids. PTSD, depression, smoking, and dust exposure during the 2001 cleanup were self-reported. During the 4-year follow-up, outcomes were assessed through (1) interview-based incident, nonfatal MI, and stroke, validated in medical charts (n=118); and (2) hospitalizations for MI and stroke for New York city and state residents (n=180). Prevalence of PTSD was 19.9% in men and 25.9% in women, that is, at least twice that of the general population. Cumulative incidence of MI or stroke was consistently larger for men or women with PTSD across follow-up. Adjusted hazard ratios (HRs) were 2.22 (95% confidence interval [CI], 1.30-3.82) for MI and 2.51 (95% CI, 1.39-4.57) for stroke. For pooled MI and stroke, adjusted HRs were 2.35 (95% CI, 1.57-3.52) in all and 1.88 (95% CI, 1.01-3.49) in men free of depression. Using hospitalization registry data, adjusted HRs were 2.17 (95% CI, 1.41-3.32) for MI; 3.01 (95% CI, 1.84-4.93) for stroke; and for pooled MI and stroke, the adjusted HR was 2.40 (95% CI, 1.73-3.34) in all, HR was 2.44 (95% CI, 1.05-5.55) in women, and adjusted HR was 2.27 (95% CI, 1.41-3.67) in men free of depression. World Trade Center dust exposure had no effect.


This cohort study confirms that PTSD is a risk factor for MI and stroke of similar magnitude in men and women, independent of depression.


air pollution; depression; disasters; myocardial infarction; stress disorders, post-traumatic; stroke

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