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Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study

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dc.contributor Háskóli Íslands
dc.contributor University of Iceland
dc.contributor.author Song, Huan
dc.contributor.author Fang, Fang
dc.contributor.author Arnberg, Filip
dc.contributor.author Mataix-Cols, David
dc.contributor.author Fernández de la Cruz, Lorena
dc.contributor.author Almqvist, Catarina
dc.contributor.author Fall, Katja
dc.contributor.author Lichtenstein, Paul
dc.contributor.author Thorgeirsson, Gudmundur
dc.contributor.author Valdimarsdottir, Unnur
dc.date.accessioned 2020-10-08T11:16:38Z
dc.date.available 2020-10-08T11:16:38Z
dc.date.issued 2019-04-10
dc.identifier.citation Song, H., et al. (2019). "Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study." BMJ 365: l1255.
dc.identifier.issn 0959-8138 (eISSN)
dc.identifier.issn 1759-2151
dc.identifier.uri https://hdl.handle.net/20.500.11815/2100
dc.description Publisher's version (útgefin grein)
dc.description.abstract Objective To assess the association between stress related disorders and subsequent risk of cardiovascular disease. Design Population based, sibling controlled cohort study. Setting Population of Sweden. Participants 136 637 patients in the Swedish National Patient Register with stress related disorders, including post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions, from 1987 to 2013; 171 314 unaffected full siblings of these patients; and 1 366 370 matched unexposed people from the general population. Main outcome measures Primary diagnosis of incident cardiovascular disease-any or specific subtypes (ischaemic heart disease, cerebrovascular disease, emboli/thrombosis, hypertensive diseases, heart failure, arrhythmia/conduction disorder, and fatal cardiovascular disease)-and 16 individual diagnoses of cardiovascular disease. Hazard ratios for cardiovascular disease were derived from Cox models, after controlling for multiple confounders. Results During up to 27 years of follow-up, the crude incidence rate of any cardiovascular disease was 10.5, 8.4, and 6.9 per 1000 person years among exposed patients, their unaffected full siblings, and the matched unexposed individuals, respectively. In sibling based comparisons, the hazard ratio for any cardiovascular disease was 1.64 (95% confidence interval 1.45 to 1.84), with the highest subtype specific hazard ratio observed for heart failure (6.95, 1.88 to 25.68), during the first year after the diagnosis of any stress related disorder. Beyond one year, the hazard ratios became lower (overall 1.29, 1.24 to 1.34), ranging from 1.12 (1.04 to 1.21) for arrhythmia to 2.02 (1.45 to 2.82) for artery thrombosis/embolus. Stress related disorders were more strongly associated with early onset cardiovascular diseases (hazard ratio 1.40 (1.32 to 1.49) for attained age <50) than later onset ones (1.24 (1.18 to 1.30) for attained age ≥50; P for difference=0.002). Except for fatal cardiovascular diseases, these associations were not modified by the presence of psychiatric comorbidity. Analyses within the population matched cohort yielded similar results (hazard ratio 1.71 (1.59 to 1.83) for any cardiovascular disease during the first year of follow-up and 1.36 (1.33 to 1.39) thereafter). Conclusion Stress related disorders are robustly associated with multiple types of cardiovascular disease, independently of familial background, history of somatic/psychiatric diseases, and psychiatric comorbidity.
dc.description.sponsorship The study was supported by Grant of Excellence, Icelandic Research Fund (grant No 163362-051 to UAV), and ERC Consolidator Grant (StressGene, grant No 726413 to UAV); by the Karolinska Institutet (Senior Researcher Award and Strategic Research Area in Epidemiology to FF); and by the Swedish Research Council through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework (grant No 340-2013-5867 to CA).
dc.format.extent l1255
dc.language.iso en
dc.publisher BMJ
dc.relation.ispartofseries The BMJ;365
dc.rights info:eu-repo/semantics/openAccess
dc.subject Cardiovascular disease
dc.subject Stress related disorders
dc.subject Blóðrásarsjúkdómar
dc.subject Streita
dc.title Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study
dc.type info:eu-repo/semantics/article
dcterms.license This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
dc.description.version Peer Reviewed
dc.identifier.journal BMJ
dc.identifier.doi 10.1136/bmj.l1255
dc.relation.url https://www.bmj.com/content/365/bmj.l1255
dc.contributor.department Læknadeild (HÍ)
dc.contributor.department Faculty of Medicine (UI)
dc.contributor.school Heilbrigðisvísindasvið (HÍ)
dc.contributor.school School of Health Sciences (UI)

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