Severe stress post-9/11 raises heart disease risk

NEW YORK Tue Jan 8, 2008 4:47pm EST

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NEW YORK (Reuters Health) - People who felt extremely stressed directly after the terrorist attacks of September 11, 2001 were at increased risk of being diagnosed with cardiovascular problems in the following 3 years-even if they only saw the attacks on TV, a new study shows.

The risk was particularly strong for those who continued worrying about terrorism for years afterwards.

"The bottom line is the vast majority of our sample had no direct exposure, and yet their acute stress reactions are associated with subsequent heart problems," Dr. E. Alison Holman of the University of California, Irvine, one of the study's authors, told Reuters Health.

"We need to think about how we communicate risk to people. We had lots and lots of terror alerts following 9/11...none of which actually panned out. Those kinds of terror alerts could potentially be increasing people's stress or encouraging people to worry more."

Holman and her team followed a nationwide sample of 2,592 people for 3 years after the attacks. All had completed a survey of their mental and physical health before September 11, 2001.

Only 3.6 percent were directly exposed to the terrorist attacks, for example, being an eye witness or having a loved one in the Pentagon or the World Trade Center at the time of the attack. Another 63.2 percent watched the events live on TV and 33.2 percent had not seen any live coverage.

The researchers defined acute stress as having a high level of post-traumatic stress disorder (PTSD)-type symptoms within several days of the attacks, such as restlessness, feeling on edge, difficulty sleeping or intrusive thoughts of the attacks. Based on this definition, 10.7 percent of the study participants had an acute stress response.

Even after the researchers allowed for the study participants' mental and cardiovascular health before the attacks, people who reported acute stress responses were 53 percent more likely to be diagnosed with a heart attack, stroke, high blood pressure or other heart-related ailment in the following three years.

People who continued to worry about the attacks and also experienced acute stress responses were nearly five times as likely to be diagnosed with heart problems 2 years after September 11, 2001, and had three times the risk of such a diagnosis 3 years later.

The findings show that front-line health care providers must take patients' reports of stress seriously, because stress can have important health consequences, Holman noted. "Maybe some kind of intervention is called for in the immediate aftermath of a traumatic event," she added, such as biofeedback or other stress relief techniques.

Americans have much less exposure to terrorism than people living in many other parts of the world, where violence occurs on a daily basis, the researcher pointed out. "If people who are indirectly exposed are having problems, one can only imagine what's going on for the population of other parts of the world," she said.

SOURCE: Archives of General Psychiatry, January 2008.

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