Comorbidities such as smoking, anxiety and depression account for the increased risk of cardiovascular disease (CVD) in veterans with post-traumatic stress disorder (PTSD), according to an analysis of electronic health records.

“PTSD by itself is not an independent risk factor for cardiovascular disease,” Dr Jeffrey Scherrer of the VA Medical Center in Columbia, Missouri, and St. Louis University School of Medicine said by phone.

“That’s evidenced very strongly in the subsample of patients who had no smoking, who had no sleep disorders, that were free of depression, anxiety and other comorbidities. They had no increased risk of cardiovascular disease.”

PTSD has long been known to be associated with heart disease, but it has been unclear whether the disorder itself or comorbid conditions drive the relationship, Dr Scherrer and his team note in the Journal of the American Heart Association.