University Honors

Background: Post-traumatic stress disorder (PTSD) has been recognized as a condition associated with elevated cardiovascular risk. PTSD patients frequently present with multiple cardiovascular risk factors, such as hypertension, type 2 diabetes, hyperlipidemia, obesity, and nicotine dependence that may increase the likelihood of major adverse cardiovascular events (MACE). While the prevalence of PTSD and cardiovascular disease differs across race and sex, the relationship between PTSD and cardiovascular disease (CVD) and PTSDís impact on CVD across race and sex remains poorly defined. Objective: This study examines how the cumulative burden of cardiovascular risk factors affects the incidence of MACE among PTSD patients and evaluates whether these associations vary across race and sex. Methods: De-identified electronic health record data from the TriNetX Research Network was used to create cohorts examining PTSD patients without cardiovascular risk factors and with a varied number of risk factors, stratified by race and sex. Propensity score matching was applied within each comparison to balance cohorts for age, sex, and psychiatric comorbidities. Logistic and Cox proportional hazards models were used to estimate risk difference, risk ratio, odds ratio, and hazard ratio for MACE across increasing numbers of risk factors across race and sex. Additional generalized linear modeling tested for two way and three way interactions between number of cardiovascular risk factors, race, and sex to assess potential subgroup differences. Results: Across all PTSD patients, MACE incidence increased steadily with each additional cardiovascular risk factor. Compared to matched baseline cohorts (no risk factors), MACE risk increased by 0.6-1.0% with one risk factor, 4-5% with two risk factors, and more than 20% with four or more risk factors (all p < 0.0001). A separate subanalysis by sex identified greater increased MACE risk increase per factor for women, while race did not significantly alter the slope. The three way interaction between the number of risk factors, race, and sex was not significant, indicating that the risk accumulation trends were similar across all race and sex subgroups. Conclusion: Each additional cardiovascular risk factor significantly increases the absolute and relative risk of MACE in PTSD patients, independent of race or sex. The absence of significant racial difference suggests that when patients are propensity score matched, multimorbidity burden is the primary determinant of cardiovascular outcomes, instead of demographic identity. These findings show the importance of comprehensive cardiovascular screening and risk factor management in PTSD care.