In today’s era of mind-body medicine we continue to gain a more sophisticated understanding of the effects of trauma on cardiovascular and cerebrovascular functioning. Such information complements our comparatively vast knowledge concerning the psychological and psychosocial effects of trauma. Acute psychological stress and chronic stress disorders, including PTSD have been linked to increased risk of vascular events in older adults (eg, hypertension, metabolic syndrome, myocardial infarction, stroke).1
Based on emerging data, this generation of young people may have a unique risk of exposure to stress and researchers and clinicians are increasingly concerned about the long-term health consequences of such chronic exposure for young adults.2 In addition to a potential history of early life adversity (eg, sexual or physical abuse) and chronic stress, young people in the general population are increasingly exposed to extremely stressful or traumatic life events and the associated aftermath of events like gun violence and natural disaster.
Moreover, PTSD may develop after indirect or vicarious exposure to trauma (eg, repeatedly watching acts of violence or terrorism online). Those indirect experiences may be more accessible than ever and may contribute to worse long-term health outcomes, particularly for victims of multiple traumas.3,4
PTSD and vascular risk
Of the cardiovascular and cerebrovascular conditions associated with PTSD, stroke is often thought of as a disease of later life, a perception that may result in the underdiagnosis of stroke among young adults. An estimated 10% to 14% of strokes occur in adults aged 45 and younger and the incidence of ischemic stroke and transient ischemic attack (TIA) among young adults has steadily increased over the past decade.5,6 Nearly 50% of stroke cases among young adults are attributed to traditional cardiovascular risk factors such as hypertension, smoking, and diabetes. Strikingly, many more (40% to 50%) of cases are due to undetermined etiologies.7,8
These statistics are especially worrisome given the significant psychological, physical, and financial effects of stroke on young adults in the prime of their life, on their loved ones, and on the health care system. Yet, young adults remain largely underrepresented in epidemiological research and randomized clinical trials. That omission makes it difficult to investigate potential age-specific contributory mechanisms and to develop novel therapeutic strategies to curb the growing burden of stroke in the young.
The causes, characteristics, and consequences of stroke for young patients likely differ from those observed in the average stroke patient who is generally older and is more likely to have concomitant disease. Over the years, many traditional and non-traditional risk factors for stroke in young adults have been identified (Table). Cross-sectional evidence suggests that trauma exposure and PTSD are risk factors for stroke among older adults and highlights psychological stress as a greater predictor of stroke among young adults relative to older individuals.9
Disclosures:
Dr Gaffey is a Postdoctoral Research Fellow, Department of Internal Medicine, Division of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT; and an Advances Research Fellow in Women’s Health, VA Connecticut Healthcare System, West Haven, CT. Dr Sico is Associate Professor, Department of Internal Medicine, Section of General Medicine; Associate Professor, Department of Neurology and Center for Neuroepidemiological and Clinical Neurological Research, Yale School of Medicine; and Director Stroke Care, VA Connecticut Healthcare System. Dr Rosman is Assistant Professor, Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC. The authors report no conflicts of interest concerning the subject matter of this article.
References:
1. Coughlin SS. Post-traumatic stress disorder and cardiovascular disease. Open Cardiovasc Med J. 2011;5:164-170.
2. Twenge JM, Cooper AB, Joiner TE, et al. Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017. J Abnorm Psychol. 2019;128:185-199.
3. Baird K, Kracen AC. Vicarious traumatization and secondary traumatic stress: a research synthesis. Counsel Psychol Q. 2006;19:181-188.
4. Pai A, Suris AM, North CS. Posttraumatic stress disorders in the DSM-5: controversy, change, and conceptual considerations. Behav Sci. 2017:7:7.
5. Putaala J. Ischemic stroke in the young: current perspectives on incidence, risk factors, and cardiovascular prognosis. Eur Stroke J. 2016;1:28-40.
6. Sultan S, Elkind MS. Stroke in young adults: on the rise? Neurology. 2012;79:1752-1753.
7.Putaala J. Ischemic stroke in the young: current perspectives on incidence, risk factors, and cardiovascular prognosis. Eur Stroke J. 2016;1:28-40.
8. Yesilot Barlas N, Putaala J. Waje-Andreassen U, et al. Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013;20:1431-1439.
9. O’Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries: a case control study. Lancet. 2016;388:761-775.
10. Rosman L, Sico JJ, Lampert R, et al. Posttraumatic stress disorder and risk for stroke in young and middle-aged adults: a 13-year cohort study. Stroke. 2019;50:2996-3003.
11. Kudielka BM, Kirschbaum C. Sex differences in HPA axis responses to stress: a review. Biol Psychol. 2005;69:113-132.
12. Bale TL, Epperson CN. Sex differences and stress across the lifespan. Nat Neurosci. 2015;18:1413-1420.
13. Edmondson D, Kronish IM, Shaffer JA, et al. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J. 2013;166:806-814.
14. Sands MR, Lauderdale DS, Liu K, et al. Short sleep duration is associated with carotid intima-media thickness among men in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Stroke. 2012;43:2858-2864.
15. Cappuccio FP, Cooper D, D’elia L, et al. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32:1484-1492.
16. Barone DA, Krieger AC. Stroke and obstructive sleep apnea: a review. Curr Atheroscler Rep. 2013;15:334.
17. Fang J, Wheaton AG, Ayala C. Sleep duration and history of stroke among adults from the USA. J Sleep Res. 2014;23:531-537.
18. Gaffey AE, Redeker NS, Rosman L, et al. The role of insomnia in the association between posttraumatic stress disorder and hypertension. J Hypertens. November 2019; E-pub ahead of print.
19. Maaijwee NA, Rutten-Jacobs LC, Schaapsmeerders P, et al. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol. 2014;10:315.
20. Baird K, Kracen AC. Vicarious traumatization and secondary traumatic stress: a research synthesis. Counsel Psychol Q. 2006;19:181-188.
21. Matud MP. Gender differences in stress and coping styles. Pers Ind Diff. 2004;37:1401-1415.
"lasting" - Google News
February 29, 2020 at 05:06AM
https://ift.tt/2uFgszb
Stroke in Young Adults: The Lasting Effects of Trauma - Psychiatric Times
"lasting" - Google News
https://ift.tt/2tpNDpA
Shoes Man Tutorial
Pos News Update
Meme Update
Korean Entertainment News
Japan News Update
Bagikan Berita Ini
0 Response to "Stroke in Young Adults: The Lasting Effects of Trauma - Psychiatric Times"
Post a Comment